Provider Demographics
NPI:1891318267
Name:EMPIRE SPECIALTY PHARMACY LLC
Entity Type:Organization
Organization Name:EMPIRE SPECIALTY PHARMACY LLC
Other - Org Name:APOLLO PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:NAGA LAXMI
Authorized Official - Last Name:CHEEDHELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-549-5005
Mailing Address - Street 1:749 S APOLLO BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1457
Mailing Address - Country:US
Mailing Address - Phone:321-549-6926
Mailing Address - Fax:321-549-6419
Practice Address - Street 1:749 S APOLLO BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1457
Practice Address - Country:US
Practice Address - Phone:321-960-8621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy