MEDICARE: MAHANT PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BC3200X	Customized Equipment (DME)
3	3336C0004X	Compounding Pharmacy
4	3336C0003X	Community/Retail Pharmacy	PH30595	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477731305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHANT PHARMACY INC

Provider Business Mailing Address
First Line	:	1550 SE FLORESTA DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-4069
Country	:	US
Telephone Number	:	772-340-4142
Fax Number	:	772-785-5753

Provider Business Practice Location Address
First Line	:	1550 SE FLORESTA DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-4069
Country	:	US
Telephone Number	:	772-340-4142
Fax Number	:	772-785-5753

Authorized Official
Title or Position	:	PRESIDENT
Name	:	URMIL SHAH
Credential	:
Telephone Number	:	848-667-3791

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	06/29/2021

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Directions to “MAHANT PHARMACY INC ” Practice Location

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