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General NPI Number Information
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NPI Number | 1659764959
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Entity Type | Organization
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Legal Business Name | AVA KEROLOS LLC
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Dates
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Enumeration Date | 03/10/2015
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 33338 U.S. HWY 19 N.
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City | PALM HARBOR
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State | FL
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Zip | 34684
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Country | US
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Telephone | 727-785-2640
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Fax | 727-784-0701
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Provider Business Mailing Address
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Address Line | 33338 U.S. HWY 19 N.
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City | PALM HARBOR
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State | FL
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Zip | 34684
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Country | US
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Telephone | 727-785-2650
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Fax | 727-785-2827
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Authorized Official
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Title or Position | OWNER
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Name | EMAN ROUFAIL
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Credential |
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Telephone | 615-554-8105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH28867
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License Number State | FL
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