MYCELIUM PHARMACY LLC NPI 1487252391

NPI Information

MYCELIUM PHARMACY LLC is a pharmacy in Ft Lauderdale, FL. The provider is a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. MYCELIUM PHARMACY LLC NPI is 1487252391. The provider is registered as an organization entity type.

The provider's business location address is:

141 E COMMERCIAL BLVD
FT LAUDERDALE, FL
ZIP 33334-623
Phone: (954) 616-5675

The provider's authorized official is Marko Jaric .
The authorized official title is Owner and has the following contact phone number (954) 616-5675.

The enumeration date for this NPI number is 10/13/2020 and was last updated on 10/13/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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