Provider Demographics
NPI:1073399523
Name:MAHEEM ENTERPRISE LLC
Entity Type:Organization
Organization Name:MAHEEM ENTERPRISE LLC
Other - Org Name:BABCOCK PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEVANG
Authorized Official - Middle Name:N
Authorized Official - Last Name:MODI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:321-499-3999
Mailing Address - Street 1:1515 PALM BAY RD STE 108
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3863
Mailing Address - Country:US
Mailing Address - Phone:321-499-3999
Mailing Address - Fax:321-499-3994
Practice Address - Street 1:1515 PALM BAY RD STE 108
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32905-3863
Practice Address - Country:US
Practice Address - Phone:321-499-3999
Practice Address - Fax:321-499-3994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy