Healthcare Provider Details

I. General information

NPI: 1407550528
Provider Name (Legal Business Name): ADW DIABETES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MARKET ST STE 108B
SAINT AUGUSTINE FL
32095-8803
US

IV. Provider business mailing address

2501 NW 34TH PL STE 35
POMPANO BEACH FL
33069-5930
US

V. Phone/Fax

Practice location:
  • Phone: 877-241-9002
  • Fax: 954-975-3786
Mailing address:
  • Phone: 877-241-9002
  • Fax: 954-975-3786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MICHAEL MCMAHON
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 877-241-9002