Organization
MANGALMURTI LLC
Active
Other names
Mount Dora Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JIMIN PATEL (OWNER)
(352) 357-1406
Entity
Organization
Contact information
Practice address
17435 US HIGHWAY 441, SUITE-102, EUSTIS, FL 32726
(352) 357-1406
(352) 357-1402
Mailing address
17435 US HIGHWAY 441 STE 102, MOUNT DORA, FL 32757-6750
(352) 357-1406
(352) 357-1402
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH26261
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006612500
—
FL
01
—
2135382
PK
—
Enumeration date
05/31/2012
Last updated
11/23/2022
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