Provider Demographics
NPI:1730714130
Name:VIRGIN MARYS PHARMACY CORP
Entity type:Organization
Organization Name:VIRGIN MARYS PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMONYOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELMALAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-252-7799
Mailing Address - Street 1:25710 FRITH ST
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-5682
Mailing Address - Country:US
Mailing Address - Phone:813-505-6684
Mailing Address - Fax:
Practice Address - Street 1:14606 N DALE MABRY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618
Practice Address - Country:US
Practice Address - Phone:813-505-6684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy