Healthcare Provider Details

I. General information

NPI: 1578560074
Provider Name (Legal Business Name): D.B.M. DISTRIBUTORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 CRANDON BLVD
KEY BISCAYNE FL
33149-2008
US

IV. Provider business mailing address

614 CRANDON BLVD
KEY BISCAYNE FL
33149-2008
US

V. Phone/Fax

Practice location:
  • Phone: 305-361-5445
  • Fax: 305-361-1064
Mailing address:
  • Phone: 305-361-5445
  • Fax: 305-361-1064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0006630
License Number StateFL

VIII. Authorized Official

Name: MR. MARC A. PORT
Title or Position: OWNER
Credential: RPH
Phone: 305-361-5445