Organization
MEDOZ PHARMACY OF POLK LLC
Active
Other names
f/k/a Medoz Pharmacy of Polk Inc
Organization subpart
No
Provider details
NPI number
Authorized official
ABRAHAM MERMELSTEIN (MANAGING MEMBER)
(732) 267-7782
Entity
Organization
Contact information
Practice address
40230 US HIGHWAY 27 N, SUITE 100-110, DAVENPORT, FL 33837-2636
(855) 633-6948
(844) 329-6348
Mailing address
40230 US HIGHWAY 27 N, SUITE 100-110, DAVENPORT, FL 33837-2636
(855) 633-6948
(844) 329-6348
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PH28722
FL
3336C0003X
Community/Retail Pharmacy
Primary
PH28722
FL
3336C0004X
Compounding Pharmacy
PS28722
FL
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014712100
—
FL
01
—
PH28722
PHARMACY STATE LICENSE NUMBER
FL
Enumeration date
11/24/2014
Last updated
08/25/2022
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