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General NPI Number Information
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NPI Number | 1891722898
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Entity Type | Organization
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Legal Business Name | EXPRESS MEDICAL & NUTRITION SUPPLY INC.
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 6201 JOHNS RD SUITE 4
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City | TAMPA
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State | FL
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Zip | 33634-4434
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Country | US
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Telephone | 813-885-3444
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Fax | 813-885-1729
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Provider Business Mailing Address
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Address Line | 6201 JOHNS RD SUITE 4
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City | TAMPA
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State | FL
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Zip | 33534
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Country | US
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Telephone | 813-885-3444
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Fax | 813-885-1729
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Authorized Official
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Title or Position | OWNER
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Name | MR. JACK PICKENS
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Credential |
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Telephone | 813-885-3444
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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 | 3980120428317
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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 | 3980120428317
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License Number State | FL
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