Provider Demographics
NPI:1730503889
Name:EXPRESS SPECIALTY PHARMACY
Entity type:Organization
Organization Name:EXPRESS SPECIALTY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PIC
Authorized Official - Prefix:
Authorized Official - First Name:OSAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:AL NAJJAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-418-9991
Mailing Address - Street 1:7303 N NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-4918
Mailing Address - Country:US
Mailing Address - Phone:813-288-0777
Mailing Address - Fax:888-494-7084
Practice Address - Street 1:7303 N NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-4918
Practice Address - Country:US
Practice Address - Phone:813-288-0777
Practice Address - Fax:888-494-7084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH271193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010821600Medicaid
2144254OtherPK