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General NPI Number Information
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NPI Number | 1346647005
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Entity Type | Organization
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Legal Business Name | MEDOZ PHARMACY OF POLK LLC
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 40230 US HIGHWAY 27 N SUITE 100-110
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City | DAVENPORT
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State | FL
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Zip | 33837-2636
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Country | US
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Telephone | 855-633-6948
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Fax | 844-329-6348
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Provider Business Mailing Address
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Address Line | 40230 US HIGHWAY 27 N SUITE 100-110
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City | DAVENPORT
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State | FL
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Zip | 33837-2636
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Country | US
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Telephone | 855-633-6948
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Fax | 844-329-6348
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ABRAHAM MERMELSTEIN
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Credential |
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Telephone | 732-267-7782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PS28722
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PH28722
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH28722
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License Number State | FL
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