MEDICARE: DR. LILY KHODADOOST-KAMVAR PHARM D, RPH

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	183500000X	Pharmacist	021840	KY
2	183500000X	Pharmacist	123173	MN
3	183500000X	Pharmacist	PS53347	FL
4	183500000X	Pharmacist	6718	CT
5	183500000X	Pharmacist	03440357	OH

General Provider Information

NPI Number	:	1710965751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LILY KHODADOOST-KAMVAR PHARM D, RPH

Provider Business Mailing Address
First Line	:	841 ARBORMOOR PL
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-7019
Country	:	US
Telephone Number	:	203-581-9358
Fax Number	:

Provider Business Practice Location Address
First Line	:	6700 CONROY RD STE 155
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3515
Country	:	US
Telephone Number	:	407-673-2222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	01/29/2026

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