Healthcare Provider Details

I. General information

NPI: 1821926189
Provider Name (Legal Business Name): MAGNOLIA PHARMACYONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 OLD CAMP RD STE 170
THE VILLAGES FL
32162-5609
US

IV. Provider business mailing address

910 OLD CAMP RD STE 170
THE VILLAGES FL
32162-5609
US

V. Phone/Fax

Practice location:
  • Phone: 201-736-4738
  • Fax: 904-820-2018
Mailing address:
  • Phone: 201-736-4738
  • Fax: 904-820-2018

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: PARTH PATEL
Title or Position: OWNER
Credential:
Phone: 201-736-4738