MEDICARE: LOTUS PHARMACY 1, 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	3336L0003X	Long Term Care Pharmacy

General Provider Information

NPI Number	:	1093664229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS PHARMACY 1, LLC

Provider Business Mailing Address
First Line	:	5410 NW 33RD AVE STE 107
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-0004
Country	:	US
Telephone Number	:	833-602-3336
Fax Number	:	888-756-3331

Provider Business Practice Location Address
First Line	:	5410 NW 33RD AVE STE 107
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-0004
Country	:	US
Telephone Number	:	833-602-3336
Fax Number	:	888-756-3331

Authorized Official
Title or Position	:	CEO
Name	:	JILL LYTWYN
Credential	:
Telephone Number	:	612-425-9145

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/30/2026

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Directions to “LOTUS PHARMACY 1, LLC ” Practice Location

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