Healthcare Provider Details

I. General information

NPI: 1316592538
Provider Name (Legal Business Name): AV PHARMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 UNIVERSITY BLVD N STE B
JACKSONVILLE FL
32211-5229
US

IV. Provider business mailing address

PO BOX 600047
JACKSONVILLE FL
32260-0047
US

V. Phone/Fax

Practice location:
  • Phone: 877-811-1129
  • Fax: 855-811-3423
Mailing address:
  • Phone: 877-811-1129
  • Fax: 855-811-3423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VIPUL MAMTORA
Title or Position: DIRECTOR
Credential:
Phone: 877-811-1129