Healthcare Provider Details

I. General information

NPI: 1750004149
Provider Name (Legal Business Name): TAULANT KOCA PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N AVALON PARK BLVD
ORLANDO FL
32828-6666
US

IV. Provider business mailing address

1000 N AVALON PARK BLVD
ORLANDO FL
32828-6666
US

V. Phone/Fax

Practice location:
  • Phone: 407-736-8045
  • Fax: 407-736-8493
Mailing address:
  • Phone: 407-736-8045
  • Fax: 407-736-8493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS64707
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: