Provider Demographics
NPI:1407833437
Name:ARYAN RETAIL LLC
Entity Type:Organization
Organization Name:ARYAN RETAIL LLC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:239-369-0141
Mailing Address - Street 1:57 HOMESTEAD RD N
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-6607
Mailing Address - Country:US
Mailing Address - Phone:239-369-0141
Mailing Address - Fax:
Practice Address - Street 1:57 HOMESTEAD RD N
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6607
Practice Address - Country:US
Practice Address - Phone:239-369-0141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1051200OtherNCPDP #
FLBA7487374OtherDEA #
FL1051200OtherNCPDP #