Healthcare Provider Details

I. General information

NPI: 1083921860
Provider Name (Legal Business Name): MEDOZ PHARMACY OF OSCEOLA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W OAK ST STE 114
KISSIMMEE FL
34741-4989
US

IV. Provider business mailing address

720 W OAK ST STE 114
KISSIMMEE FL
34741-4989
US

V. Phone/Fax

Practice location:
  • Phone: 407-374-2550
  • Fax: 407-347-4097
Mailing address:
  • Phone: 407-374-2550
  • Fax: 407-347-4097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number24831
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: UDAYKUMAR DESAI
Title or Position: CEO
Credential:
Phone: 407-374-2550