Healthcare Provider Details

I. General information

NPI: 1447171962
Provider Name (Legal Business Name): AVELLUM HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 HERITAGE DR STE 143
JUPITER FL
33458-5287
US

IV. Provider business mailing address

555 HERITAGE DR STE 143
JUPITER FL
33458-5287
US

V. Phone/Fax

Practice location:
  • Phone: 561-941-3900
  • Fax: 561-941-3898
Mailing address:
  • Phone: 561-941-3900
  • Fax: 561-941-3898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KHALED ALHAMZAWI
Title or Position: COMPLIANCE
Credential:
Phone: 704-858-0534