Healthcare Provider Details

I. General information

NPI: 1891567426
Provider Name (Legal Business Name): ADYA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1572 CITRUS MEDICAL CT
OCOEE FL
34761-4547
US

IV. Provider business mailing address

1572 CITRUS MEDICAL CT
OCOEE FL
34761-4547
US

V. Phone/Fax

Practice location:
  • Phone: 407-337-5250
  • Fax: 407-337-5251
Mailing address:
  • Phone: 407-337-5250
  • Fax: 407-337-5251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SHASANKA THUMU
Title or Position: PHAMACY MANAGER
Credential: PHARMD
Phone: 407-337-5250