Healthcare Provider Details

I. General information

NPI: 1477875607
Provider Name (Legal Business Name): MED PHARMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2010
Last Update Date: 02/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6908 BEACH DR
PANAMA CITY BEACH FL
32408-6023
US

IV. Provider business mailing address

6908 BEACH DR
PANAMA CITY BEACH FL
32408-6023
US

V. Phone/Fax

Practice location:
  • Phone: 334-791-2799
  • Fax: 850-249-4895
Mailing address:
  • Phone: 334-791-2799
  • Fax: 850-249-4895

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 Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. LEO M BULLOCK IV
Title or Position: PRESIDENT / MANAGING MEMBER
Credential:
Phone: 334-791-2799