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	3336M0002X	Mail Order Pharmacy

General Provider Information

NPI Number	:	1316592538
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	:	877-811-1129
Fax Number	:	855-811-3423

Provider Business Practice Location Address
First Line	:	1545 UNIVERSITY BLVD N STE B
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5229
Country	:	US
Telephone Number	:	877-811-1129
Fax Number	:	855-811-3423

Authorized Official
Title or Position	:	DIRECTOR
Name	:	VIPUL MAMTORA
Credential	:
Telephone Number	:	877-811-1129

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	12/15/2025

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Directions to “AV PHARMA LLC ” Practice Location

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