MEDICARE: DIABETIC CARE RX LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	PH22190	FL
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	333600000X	Pharmacy
4	3336C0003X	Community/Retail Pharmacy
5	3336C0004X	Compounding Pharmacy
6	3336M0002X	Mail Order Pharmacy
7	3336H0001X	Home Infusion Therapy Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2006491	OTHER		PK

General Provider Information

NPI Number	:	1417978479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETIC CARE RX LLC

Provider Business Mailing Address
First Line	:	3890 PARK CENTRAL BLVD N
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-2264
Country	:	US
Telephone Number	:	866-348-0441
Fax Number	:	888-443-5034

Provider Business Practice Location Address
First Line	:	3890 PARK CENTRAL BLVD N
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-2264
Country	:	US
Telephone Number	:	866-348-0441
Fax Number	:	888-443-5034

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	DENISE HEFLEY
Credential	:	PHARM D
Telephone Number	:	866-348-0441

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	09/26/2018

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