Healthcare Provider Details

I. General information

NPI: 1396329538
Provider Name (Legal Business Name): PHARAOHS TRADING L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 S NOVA RD
ORMOND BEACH FL
32174-7332
US

IV. Provider business mailing address

743 S NOVA RD
ORMOND BEACH FL
32174-7332
US

V. Phone/Fax

Practice location:
  • Phone: 386-366-2016
  • Fax: 386-238-9845
Mailing address:
  • Phone: 386-366-2016
  • 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 Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER GENDI
Title or Position: OWNER
Credential:
Phone: 386-366-2016