Organization
MEDLIFE PHARMACY LLC
Active
Other names
wintergarden pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
VAMSEE CHARAN NALAGANDLA (PHARMACY MANAGER)
(407) 656-2604
Entity
Organization
Contact information
Practice address
736 S DILLARD ST UNIT C, WINTER GARDEN, FL 34787-3908
(407) 656-2604
(407) 654-1464
Mailing address
736 S DILLARD ST UNIT C, WINTER GARDEN, FL 34787-3908
(407) 656-2604
(407) 654-1464
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH29430
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014189300
—
FL
01
—
2154708
PK
—
Enumeration date
03/10/2014
Last updated
07/19/2021
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