Provider Demographics
NPI:1871097683
Name:MED AND Z INVESTMENT LLC
Entity type:Organization
Organization Name:MED AND Z INVESTMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMBELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-549-5599
Mailing Address - Street 1:PO BOX 48545
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0122
Mailing Address - Country:US
Mailing Address - Phone:813-410-8946
Mailing Address - Fax:813-433-5128
Practice Address - Street 1:8207 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-3003
Practice Address - Country:US
Practice Address - Phone:813-549-5599
Practice Address - Fax:813-433-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH308163336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018925900Medicaid