MEDICARE: L VASSAR INC

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	PH0016826	FL

General Provider Information

NPI Number	:	1588647788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L VASSAR INC

Provider Business Mailing Address
First Line	:	599 S FEDERAL HWY
Second Line	:
City	:	DANIA
State	:	FL
Zip	:	33004-4107
Country	:	US
Telephone Number	:	954-923-6322
Fax Number	:	954-923-6727

Provider Business Practice Location Address
First Line	:	599 S FEDERAL HWY
Second Line	:
City	:	DANIA
State	:	FL
Zip	:	33004-4107
Country	:	US
Telephone Number	:	954-923-6322
Fax Number	:	954-923-6727

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MS. LYNN M VASSAR
Credential	:	RPH
Telephone Number	:	954-923-6322

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	08/22/2020

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