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General NPI Number Information
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NPI Number | 1578560074
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Entity Type | Organization
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Legal Business Name | D.B.M. DISTRIBUTORS
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Dates
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Enumeration Date | 06/30/2005
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | 614 CRANDON BLVD
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City | KEY BISCAYNE
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State | FL
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Zip | 33149-2008
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Country | US
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Telephone | 305-361-5445
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Fax | 305-361-1064
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Provider Business Mailing Address
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Address Line | 614 CRANDON BLVD
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City | KEY BISCAYNE
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State | FL
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Zip | 33149-2008
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Country | US
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Telephone | 305-361-5445
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Fax | 305-361-1064
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARC A. PORT
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Credential | RPH
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Telephone | 305-361-5445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 0006630
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License Number State | FL
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