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NPI Code Detail

MEDICARE: SUPER SAVER PHARMACY #NO 2 LLC

MEDICARE: SUPER SAVER PHARMACY #NO 2 LLC
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
13336C0003XCommunity/Retail PharmacyPH21929FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11018692OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1871548602
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPER SAVER PHARMACY #NO 2 LLC
Provider Business Mailing Address
First Line : 2701 MICHIGAN AVE
Second Line :
City : KISSIMMEE
State : FL
Zip : 34744-1214
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 200 PARK PLACE BLVD
Second Line :
City : KISSIMMEE
State : FL
Zip : 34741-2344
Country : US
Telephone Number : 407-846-0765
Fax Number : 407-846-0738
Authorized Official
Title or Position : OWNER
Name : DEVAN MATHURA
Credential :
Telephone Number : 407-343-1230
Provider Enumeration Date : 05/23/2006
Last Update Date : 08/22/2020

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Directions to “SUPER SAVER PHARMACY #NO 2 LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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