Provider Demographics
NPI:1730618554
Name:RIGHTBACK LLC
Entity type:Organization
Organization Name:RIGHTBACK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MCEWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-765-7651
Mailing Address - Street 1:6802 W HILLSBOROUGH AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5004
Mailing Address - Country:US
Mailing Address - Phone:813-765-7651
Mailing Address - Fax:813-867-3232
Practice Address - Street 1:6802 W HILLSBOROUGH AVE STE 12
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5004
Practice Address - Country:US
Practice Address - Phone:813-765-7651
Practice Address - Fax:813-867-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
FLPH302313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169702OtherPK