Provider Demographics
NPI:1336128396
Name:CAMILLUS PHARMACY LC
Entity Type:Organization
Organization Name:CAMILLUS PHARMACY LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-221-3441
Mailing Address - Street 1:10780 W FLAGLER ST
Mailing Address - Street 2:#15
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174
Mailing Address - Country:US
Mailing Address - Phone:305-221-3441
Mailing Address - Fax:305-221-3466
Practice Address - Street 1:10780 W FLAGLER ST
Practice Address - Street 2:#15
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174
Practice Address - Country:US
Practice Address - Phone:305-221-3441
Practice Address - Fax:305-221-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPH18444333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4644400001Medicare ID - Type Unspecified