Healthcare Provider Details

I. General information

NPI: 1275645103
Provider Name (Legal Business Name): DMD PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13460 SW 10TH ST STE 101
PEMBROKE PINES FL
33027-1833
US

IV. Provider business mailing address

110 CENTURY BLVD 1ST FLOOR
WEST PALM BEACH FL
33417-2262
US

V. Phone/Fax

Practice location:
  • Phone: 954-450-0212
  • Fax: 954-450-2808
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH20124
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID ROMBRO
Title or Position: PRES
Credential:
Phone: 954-944-4104