Healthcare Provider Details

I. General information

NPI: 1609564327
Provider Name (Legal Business Name): MYDOSEPACK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10575 US HIGHWAY 19 N
PINELLAS PARK FL
33782-3424
US

IV. Provider business mailing address

10575 US HIGHWAY 19 N
PINELLAS PARK FL
33782-3424
US

V. Phone/Fax

Practice location:
  • Phone: 813-285-9365
  • Fax:
Mailing address:
  • Phone: 727-572-7002
  • Fax: 727-572-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VISHAL MALKAN
Title or Position: MANAGING MEMBER
Credential:
Phone: 813-285-9365