MEDICARE: EMERALD COMPOUNDING PHARMACY, 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	333600000X	Pharmacy

General Provider Information

NPI Number	:	1508619966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERALD COMPOUNDING PHARMACY, LLC

Provider Business Mailing Address
First Line	:	5325 PRIMROSE LAKE CIR STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3540
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5325 PRIMROSE LAKE CIR STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3540
Country	:	US
Telephone Number	:	321-321-3313
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. AHMAD GHROUF
Credential	:
Telephone Number	:	321-321-3313

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	03/09/2026

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