Organization
MS LUTZ LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN GOODKIN (OWNER)
(561) 208-1097
Entity
Organization
Contact information
Practice address
16142 FLIGHT PATH DR, BROOKSVILLE, FL 34604-6845
(561) 543-4440
(888) 891-1847
Mailing address
16142 FLIGHT PATH DR, BROOKSVILLE, FL 34604-6845
(561) 543-4440
(888) 891-1847
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PH31405
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177712
PK
—
Enumeration date
05/14/2018
Last updated
03/19/2019
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