=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215799697
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDINAL MEDICAL SUPPLY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2024
-----------------------------------------------------
Last Update Date | 04/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2335 TAMIAMI TRL N STE 208B
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34103-4457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-206-2959
-----------------------------------------------------
Fax | 832-218-1801
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 390 HAWSER LN
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-5078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-216-0695
-----------------------------------------------------
Fax | 832-218-1801
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RENEE PARRISH
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 239-206-2959
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------