Provider Demographics
NPI:1538472261
Name:REPUBLIC PHARMACY
Entity type:Organization
Organization Name:REPUBLIC PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SIMPLICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESSOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-379-8585
Mailing Address - Street 1:106 S PARSONS AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5225
Mailing Address - Country:US
Mailing Address - Phone:813-653-4802
Mailing Address - Fax:
Practice Address - Street 1:106 S PARSONS AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5225
Practice Address - Country:US
Practice Address - Phone:813-653-4802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH247073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy