Provider Demographics
NPI:1609231331
Name:OUSIA PHARMACY CORP
Entity type:Organization
Organization Name:OUSIA PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-405-9504
Mailing Address - Street 1:5194 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609
Mailing Address - Country:US
Mailing Address - Phone:813-252-4076
Mailing Address - Fax:320-455-9299
Practice Address - Street 1:5194 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609
Practice Address - Country:US
Practice Address - Phone:813-252-4076
Practice Address - Fax:320-455-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH296163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104856400Medicaid
2157530OtherPK