Organization
MAI PHARMACY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DUC PHAN (PHARMACY MANAGER)
(407) 898-2055
Entity
Organization
Contact information
Practice address
1821 E COLONIAL DR, ORLANDO, FL 32803-4805
(407) 898-2055
(407) 898-6918
Mailing address
1821 E COLONIAL DR, ORLANDO, FL 32803-4805
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH22311
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1022639
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/20/2006
Last updated
08/22/2020
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