MEDICARE: ADOM HEALTHCARE 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
2	3336C0003X	Community/Retail Pharmacy	PH30234	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2162275	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588016315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADOM HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	7347 SPRING HILL DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-4300
Country	:	US
Telephone Number	:	352-515-6311
Fax Number	:	352-515-6371

Provider Business Practice Location Address
First Line	:	7347 SPRING HILL DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-4300
Country	:	US
Telephone Number	:	352-515-6311
Fax Number	:	352-515-6371

Authorized Official
Title or Position	:	OWNER
Name	:	NADEGE CASSEUS
Credential	:
Telephone Number	:	352-515-6311

Provider Enumeration Date	:	07/05/2016
Last Update Date	:	03/06/2017

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Directions to “ADOM HEALTHCARE LLC ” Practice Location

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