Provider Demographics
NPI:1629006291
Name:LEAVITT PHARMACY, LLC
Entity Type:Organization
Organization Name:LEAVITT PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER / SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MORELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-875-2080
Mailing Address - Street 1:2600 LAKE LUCIEN DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7233
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-875-0518
Practice Address - Street 1:187 SABAL PALM DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2595
Practice Address - Country:US
Practice Address - Phone:407-478-2799
Practice Address - Fax:407-478-2798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH220203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy