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General NPI Number Information
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NPI Number | 1386837870
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Entity Type | Organization
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Legal Business Name | MY PHARMACY CLOSED DOOR PHARMACY
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | 15043 S DIXIE HWY SUITE A
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City | PALMETTO BAY
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State | FL
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Zip | 33176-7930
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Country | US
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Telephone | 305-238-2474
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Fax | 305-252-4196
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Provider Business Mailing Address
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Address Line | 15043 S DIXIE HWY SUITE A
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City | PALMETTO BAY
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State | FL
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Zip | 33176-7930
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Country | US
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Telephone | 305-238-2474
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Fax | 305-252-4196
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Authorized Official
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Title or Position | SEC TRES
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Name | MR. ORIN ELBERT SMITH JR.
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Credential | R.PH.
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Telephone | 305-238-2474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PH19817
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | PH19817
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | PH19817
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PH19817
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License Number State | FL
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