Provider Demographics
NPI:1144845157
Name:ALIGN GROUP LLC
Entity type:Organization
Organization Name:ALIGN GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAKEEM
Authorized Official - Middle Name:OLAKUNLE
Authorized Official - Last Name:FASHOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-500-8280
Mailing Address - Street 1:14960 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1626
Mailing Address - Country:US
Mailing Address - Phone:813-373-5078
Mailing Address - Fax:813-373-5378
Practice Address - Street 1:14960 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1626
Practice Address - Country:US
Practice Address - Phone:813-373-5078
Practice Address - Fax:813-373-5378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111847000Medicaid