Healthcare Provider Details

I. General information

NPI: 1245856475
Provider Name (Legal Business Name): YOUR WAY RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 FOREST HILL BLVD STE G
WEST PALM BEACH FL
33406-6073
US

IV. Provider business mailing address

1495 FOREST HILL BLVD STE G
WEST PALM BEACH FL
33406-6073
US

V. Phone/Fax

Practice location:
  • Phone: 561-703-4428
  • Fax: 561-838-7128
Mailing address:
  • Phone: 561-703-4428
  • Fax: 561-838-7128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVENSON JEAN-MARY
Title or Position: MANAGING MEMBER
Credential:
Phone: 561-703-4428