MEDICARE: RIAAN PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1003370057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIAAN PHARMACY LLC

Provider Business Mailing Address
First Line	:	4040 SUNSET LAKE DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-2841
Country	:	US
Telephone Number	:	863-816-5151
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 NEW TAMPA HWY
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33815-7364
Country	:	US
Telephone Number	:	863-816-5151
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MEMBER
Name	:	SAMIR DHADUK
Credential	:
Telephone Number	:	863-816-5151

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	03/21/2024

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Directions to “RIAAN PHARMACY LLC ” Practice Location

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