Provider Demographics
NPI:1538520234
Name:MPAM LLC
Entity type:Organization
Organization Name:MPAM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KADOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-617-2000
Mailing Address - Street 1:696 EAST ALTAMONTE DR, SUITE 1060
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-6866
Mailing Address - Country:US
Mailing Address - Phone:407-901-7777
Mailing Address - Fax:407-901-7777
Practice Address - Street 1:696 E ALTAMONTE DR
Practice Address - Street 2:SUITE#1060
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4831
Practice Address - Country:US
Practice Address - Phone:407-901-7777
Practice Address - Fax:407-901-7777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH29943333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018525500Medicaid