| Organization Name: | EMPIRE SPECIALTY PHARMACY |
| NPI Number: | 1093005753 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VENKATA NAGA LAXMI CHEEDHELLA (OWNER/DIRECTOR) |
| Mailing Address: | 1451 Dixon Blvd Cocoa |
| State: | FL US |
| Postal Code: | 329226411 |
| Phone Number: | 3215495005 |
| Fax Number: | 3215496226 |
| NPI Enumeration Date: | 04/14/2011 |
| NPI Last Update Date: | 08/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3336C0004X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Pharmacy |
| Taxonomy Specialization: | Compounding Pharmacy |
| Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |