Organization
FLORIDA KERELOS LLC
Active
Other names
EMBASSY PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
NASHAAT BOUTROS (RPH)
(727) 842-3400
Entity
Organization
Contact information
Practice address
9320 US HIGHWAY 19, PORT RICHEY, FL 34668-4772
(727) 842-3400
(727) 842-3800
Mailing address
2690 CRYSTAL CIR, DUNEDIN, FL 34698-2409
(727) 331-9806
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH25886
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5708752
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/18/2012
Last updated
07/19/2012
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