Organization
AVA KEROLOS LLC
Active
Other names
GOOD SAMARITAN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
EMAN ROUFAIL (OWNER)
(615) 554-8105
Entity
Organization
Contact information
Practice address
33338 U.S. HWY 19 N., PALM HARBOR, FL 34684
(727) 785-2640
(727) 784-0701
Mailing address
33338 U.S. HWY 19 N., PALM HARBOR, FL 34684
(727) 785-2650
(727) 785-2827
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH28867
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014789900
—
FL
01
—
2150855
PK
—
Enumeration date
03/10/2015
Last updated
12/28/2021
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