=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326983297
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEOVANCE SPECIALTY PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2026
-----------------------------------------------------
Last Update Date | 04/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 TECHNOLOGY PARK STE 158
-----------------------------------------------------
City | LAKE MARY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32746-6205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-842-2147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5025 TUGGLE RD # 100
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38118-7514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-842-2147
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | DONDRELL LESTER
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 866-842-2147
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336S0011X
-----------------------------------------------------
Taxonomy Name | Specialty Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------