Healthcare Provider Details

I. General information

NPI: 1750326955
Provider Name (Legal Business Name): PREMIUM MEDICAL EQUIPMENT SUPPLIES CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 W. FLAGER ST SUITE #108
SWEETWATER FL
33174
US

IV. Provider business mailing address

11400 W. FLAGER ST SUITE #108
SWEETWATER FL
33174
US

V. Phone/Fax

Practice location:
  • Phone: 305-825-6183
  • Fax: 305-826-4997
Mailing address:
  • Phone: 305-825-6183
  • Fax: 305-826-4997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH22467
License Number StateFL

VIII. Authorized Official

Name: YULIEMNI ESPINOSA
Title or Position: PRESIDENT
Credential:
Phone: 305-825-6183