GENC MITA

LARGO, FL
NPI1588944060
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy183500000X Pharmacist
(Licence: IL  051292841)
Additional Taxonomies183500000X Pharmacist
(Licence: FL  ps44730)
Enumeration Date2011-08-28
Last Update Date2018-03-17
Business Address
GENC MITA Pharm D
2295 E BAY DR
LARGO, FL 33771-2324
Phone number: 727-585-9810
Mailing Address
GENC MITA Pharm D
11231 COTTONWOOD DR UNIT C
PALOS HILLS, IL 60465-2537
Phone number: 708-935-8177