Provider Demographics
NPI:1952854143
Name:CARE AMERICA AT MOUNT DORA, LLC
Entity Type:Organization
Organization Name:CARE AMERICA AT MOUNT DORA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-865-7020
Mailing Address - Street 1:253 BELLAGIO CIR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-5001
Mailing Address - Country:US
Mailing Address - Phone:407-865-7020
Mailing Address - Fax:407-865-7088
Practice Address - Street 1:6909 OLD HIGHWAY 441 S
Practice Address - Street 2:STE 106
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-7039
Practice Address - Country:US
Practice Address - Phone:407-865-7020
Practice Address - Fax:407-865-7088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH300963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy