MEDICARE: MY PHARMACY CRYSTAL RIVER, 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
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1922966563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY PHARMACY CRYSTAL RIVER, LLC

Provider Business Mailing Address
First Line	:	3381 TOWN AVE
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-2168
Country	:	US
Telephone Number	:	352-404-5588
Fax Number	:

Provider Business Practice Location Address
First Line	:	3381 TOWN AVE
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-2168
Country	:	US
Telephone Number	:	352-404-5588
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	TARIQ A MUHAMMAD
Credential	:
Telephone Number	:	352-404-5588

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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