Healthcare Provider Details

I. General information

NPI: 1457973521
Provider Name (Legal Business Name): SENIOR MEDICAL AIDS & PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 N TAMIAMI TRL
NORTH FORT MYERS FL
33903-5336
US

IV. Provider business mailing address

344 E 7TH ST
SAN JACINTO CA
92583-4710
US

V. Phone/Fax

Practice location:
  • Phone: 951-392-6416
  • Fax:
Mailing address:
  • Phone: 951-392-6416
  • Fax:

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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: STEVEN MATTHEW DIMEMMO
Title or Position: OWNER
Credential:
Phone: 951-392-6416