Healthcare Provider Details

I. General information

NPI: 1376795740
Provider Name (Legal Business Name): MY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14989 S DIXIE HWY
PALMETTO BAY FL
33176-7929
US

IV. Provider business mailing address

14989 S DIXIE HWY
PALMETTO BAY FL
33176-7929
US

V. Phone/Fax

Practice location:
  • Phone: 305-238-2478
  • Fax: 305-238-0261
Mailing address:
  • Phone: 305-238-2478
  • Fax: 305-238-0261

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 Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. BERT SMITH
Title or Position: SEC TRES
Credential: RPH
Phone: 305-238-2478