Organization
EMPIRE SPECIALTY PHARMACY LLC
Active
Other names
Empire Specialty Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
VENKATA NAGA LAXMI CHEEDHELLA (PRESIDENT)
(321) 549-5005
Entity
Organization
Contact information
Practice address
378 N BABCOCK ST, MELBOURNE, FL 32935-7344
(321) 549-5005
(321) 549-6226
Mailing address
1066 CLEARLAKE RD, COCOA, FL 32922-6384
(321) 549-5005
(321) 549-6226
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH25406
FL
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003807200
—
FL
Enumeration date
04/14/2011
Last updated
10/11/2024
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