Provider Demographics
NPI:1649985284
Name:FL MEDHEALTH LLC
Entity type:Organization
Organization Name:FL MEDHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:VITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-458-4284
Mailing Address - Street 1:1400 MASON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 MASON AVE STE 100
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5501
Practice Address - Country:US
Practice Address - Phone:407-458-4284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FL MEDHEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH34050OtherPHARMACY LICENSE NUMBER