Healthcare Provider Details

I. General information

NPI: 1912636804
Provider Name (Legal Business Name): OMNICARE MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N UNIVERSITY DR STE 247
CORAL SPRINGS FL
33071-6073
US

IV. Provider business mailing address

1500 N UNIVERSITY DR STE 247
CORAL SPRINGS FL
33071-6073
US

V. Phone/Fax

Practice location:
  • Phone: 800-983-2618
  • Fax:
Mailing address:
  • Phone: 800-983-2618
  • Fax: 954-323-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO NARCISO FERNANDEZ CONSUEGRA
Title or Position: PRESIDENT
Credential:
Phone: 954-487-9879