MEDICARE: AV PHARMA 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	332B00000X	Durable Medical Equipment & Medical Supplies	PH27581	FL
2	3336S0011X	Specialty Pharmacy	PH27581	FL
3	333600000X	Pharmacy	PH27581	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	:	1184003311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AV PHARMA LLC

Provider Business Mailing Address
First Line	:	PO BOX 600047
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32260-0047
Country	:	US
Telephone Number	:	844-224-8493
Fax Number	:	844-324-8493

Provider Business Practice Location Address
First Line	:	1545 UNIVERSITY BLVD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5229
Country	:	US
Telephone Number	:	844-224-8493
Fax Number	:	844-324-8493

Authorized Official
Title or Position	:	MBR MGR
Name	:	MR. VIPUL B MAMTORA
Credential	:
Telephone Number	:	844-224-8493

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	12/15/2025

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Practice Location Address:

1545 UNIVERSITY BLVD N
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1545 UNIVERSITY BLVD N STE A
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Directions to “AV PHARMA LLC ” Practice Location

Language	Start Address	Practice Location

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