Basic Information
| Provider Information | |||||||||
| NPI: | 1629006291 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEAVITT PHARMACY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 LAKE LUCIEN DR | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | MAITLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327517233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078752080 | ||||||||
| FaxNumber: | 4078750518 | ||||||||
| Practice Location | |||||||||
| Address1: | 187 SABAL PALM DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | LONGWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327792595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074782799 | ||||||||
| FaxNumber: | 4074782798 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MORELL | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | TREASURER / SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 4078752080 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0003X | PH22020 | FL | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.