Organization
PALMYRA PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAB HARAKA (MANAGER)
(352) 213-3815
Entity
Organization
Contact information
Practice address
13080 CORTEZ BLVD, BROOKSVILLE, FL 34613-4854
(352) 600-7572
(352) 600-7675
Mailing address
13060 CORTEZ BLVD, BROOKSVILLE, FL 34613-4854
(352) 600-7572
(352) 600-7675
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
30300
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019942700
—
FL
Enumeration date
08/11/2016
Last updated
12/20/2021
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