MEDICARE: MAI 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	3336C0003X	Community/Retail Pharmacy	PH22311	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1022639	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1952483745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAI PHARMACY LLC

Provider Business Mailing Address
First Line	:	1821 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4805
Country	:	US
Telephone Number	:	407-898-2055
Fax Number	:	407-898-6918

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	DUC PHAN
Credential	:
Telephone Number	:	407-898-2055

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	08/22/2020

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Directions to “MAI PHARMACY LLC ” Practice Location

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