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General NPI Number Information
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NPI Number | 1013309293
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Entity Type | Organization
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Legal Business Name | DIABETIC CARE RX LLC
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 06/17/2016
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Provider Practice Location Address
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Address Line | 3890 PARK CENTRAL BLVD N
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City | POMPANO BEACH
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State | FL
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Zip | 33064-2264
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Country | US
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Telephone | 954-473-4717
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Fax | 954-473-9519
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Provider Business Mailing Address
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Address Line | 3890 PARK CENTRAL BLVD N
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City | POMPANO BEACH
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State | FL
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Zip | 33064-2264
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Country | US
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Telephone | 954-473-4717
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Fax | 954-473-9519
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY OPERATIONS
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Name | DENISE HEFLEY
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Credential |
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Telephone | 954-473-4717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PH22190
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License Number State | FL
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