MEDICARE: TAKA HEALTH 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	3336C0004X	Compounding Pharmacy
2	3336S0011X	Specialty Pharmacy
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy	PH25991	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2134152	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437423498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAKA HEALTH LLC

Provider Business Mailing Address
First Line	:	1084 LEE RD
Second Line	:	SUITE 4
City	:	ORLANDO
State	:	FL
Zip	:	32810-5821
Country	:	US
Telephone Number	:	407-730-2770
Fax Number	:	407-730-2764

Provider Business Practice Location Address
First Line	:	1084 LEE RD STE 4
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-5821
Country	:	US
Telephone Number	:	407-730-2770
Fax Number	:	407-730-2764

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	THANH-THUY NGUYEN
Credential	:	RPH
Telephone Number	:	407-730-2770

Provider Enumeration Date	:	03/08/2012
Last Update Date	:	03/06/2017

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Directions to “TAKA HEALTH LLC ” Practice Location

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