MEDICARE: PLAMYRA 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	30300	FL

General Provider Information

NPI Number	:	1558817783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAMYRA PHARMACY LLC

Provider Business Mailing Address
First Line	:	4817 E BUSCH BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4817 E BUSCH BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617
Country	:	US
Telephone Number	:	352-213-3815
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MOHAB HARAKA
Credential	:
Telephone Number	:	352-213-3815

Provider Enumeration Date	:	08/28/2016
Last Update Date	:	08/28/2016

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