Organization
DAYTONA SPECIALTY LLC
Active
Other names
H&R PHARMACY OF PORT ORANGE
Organization subpart
No
Provider details
NPI number
Authorized official
RAMY MALAK (OWNER)
(386) 241-0321
Entity
Organization
Contact information
Practice address
780 DUNLAWTON AVE STE 1, PORT ORANGE, FL 32127-4252
(386) 241-0321
(386) 241-0322
Mailing address
1700 FROGS LEAP CT, PORT ORANGE, FL 32128-4046
(386) 334-4920
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PH31235
PHARMACY LICENSE
FL
Enumeration date
01/23/2019
Last updated
08/05/2019
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