Healthcare Provider Details

I. General information

NPI: 1225575020
Provider Name (Legal Business Name): MILLENNIUM SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S ORLANDO AVE STE 5
WINTER PARK FL
32789-3656
US

IV. Provider business mailing address

110 S ORLANDO AVE STE 5
WINTER PARK FL
32789-3656
US

V. Phone/Fax

Practice location:
  • Phone: 407-616-1327
  • Fax:
Mailing address:
  • Phone: 407-616-1327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH30593
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TAM TU
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 407-616-1327