MEDICARE: E&M FLORIDA ENTERPRISES 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	PH30566	FL

General Provider Information

NPI Number	:	1881131316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E&M FLORIDA ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	2440 LAND O LAKES BLVD
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-4907
Country	:	US
Telephone Number	:	813-843-6687
Fax Number	:

Provider Business Practice Location Address
First Line	:	2440 LAND O LAKES BLVD
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-4907
Country	:	US
Telephone Number	:	813-843-6687
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. ESFANDIAR KHOSRAVI
Credential	:
Telephone Number	:	813-843-6687

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	01/23/2017

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