MEDICARE: MAHEEM ENTERPRISE 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	PH27315	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073928057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHEEM ENTERPRISE LLC

Provider Business Mailing Address
First Line	:	1515 PALM BAY RD STE 108
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32905-3863
Country	:	US
Telephone Number	:	321-499-3999
Fax Number	:	321-499-3994

Provider Business Practice Location Address
First Line	:	1515 PALM BAY RD STE 108
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32905-3863
Country	:	US
Telephone Number	:	321-499-3999
Fax Number	:	321-499-3994

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	DEVANG N MODI
Credential	:	RPH,MS
Telephone Number	:	201-993-5814

Provider Enumeration Date	:	06/27/2014
Last Update Date	:	09/06/2023

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Directions to “MAHEEM ENTERPRISE LLC ” Practice Location

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