Healthcare Provider Details

I. General information

NPI: 1053322693
Provider Name (Legal Business Name): DIACARERX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 S DIXIE HWY
LAKE WORTH FL
33460-3727
US

IV. Provider business mailing address

11 S DIXIE HWY
LAKE WORTH FL
33460-3727
US

V. Phone/Fax

Practice location:
  • Phone: 800-977-7698
  • Fax: 888-886-4995
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH22207
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT KREBS
Title or Position: PRESIDENT
Credential:
Phone: 800-920-0411