Mycelium Pharmacy LLC
NPI #1487252391 in Ft Lauderdale, Florida
Provider Information
- NPI Number
- 1487252391
- Entity Type
- Organization
- Organization Name
- Mycelium Pharmacy LLC
- Primary Specialty
- Pharmacy
- Enumeration Date
- Oct 13, 2020
- Last Updated
- Aug 16, 2025
Practice Location
- Address
- 141 E COMMERCIAL BLVD
- City
- Ft Lauderdale
- State
- Florida
- ZIP Code
- 33334-1623
- Phone
- (954) 616-5675
Authorized Official
- Name
- MR. DREW LAUTER
- Title
- MANAGER/OWNER
- Phone
- (954) 890-1150
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pharmacy |
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