Healthcare Provider Details

I. General information

NPI: 1972615805
Provider Name (Legal Business Name): DRM ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 N NEBRASKA AVE
TAMPA FL
33603-4013
US

IV. Provider business mailing address

PO BOX 2969
LAKELAND FL
33806-2969
US

V. Phone/Fax

Practice location:
  • Phone: 813-236-5953
  • Fax: 813-237-5120
Mailing address:
  • Phone: 863-683-2807
  • Fax: 863-682-6298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH19617
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DUANE MCKOWN
Title or Position: PRESIDENT
Credential:
Phone: 813-236-5953