Healthcare Provider Details

I. General information

NPI: 1669651840
Provider Name (Legal Business Name): LISSMART MEDICAL SUPPLIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4579 GUNN HWY
TAMPA FL
33624-6311
US

IV. Provider business mailing address

4579 GUNN HWY
TAMPA FL
33624-6311
US

V. Phone/Fax

Practice location:
  • Phone: 813-374-2452
  • Fax: 813-374-2453
Mailing address:
  • Phone: 813-374-2452
  • Fax: 813-374-2453

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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH23040
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LISVET MARTINEZ
Title or Position: PRESIDENT
Credential:
Phone: 813-417-9860