Healthcare Provider Details

I. General information

NPI: 1386568780
Provider Name (Legal Business Name): PRIME HARBOUR MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 NE 3RD ST UNIT 104
FLORIDA CITY FL
33034-3581
US

IV. Provider business mailing address

540 NE 3RD ST UNIT 104
FLORIDA CITY FL
33034-3581
US

V. Phone/Fax

Practice location:
  • Phone: 423-445-9588
  • Fax:
Mailing address:
  • Phone: 786-765-6340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: MUHAMMAD ADNAN
Title or Position: CEO
Credential:
Phone: 423-445-9588