MEDICARE: DIABETIC CARE RX LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336H0001X	Home Infusion Therapy Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	333600000X	Pharmacy
6	3336S0011X	Specialty Pharmacy	PH22190	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2150528	OTHER		PK

General Provider Information

NPI Number	:	1013309293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABETIC CARE RX LLC

Provider Business Mailing Address
First Line	:	3890 PARK CENTRAL BLVD N
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-2264
Country	:	US
Telephone Number	:	954-473-4717
Fax Number	:	954-473-9519

Provider Business Practice Location Address
First Line	:	3890 PARK CENTRAL BLVD N
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-2264
Country	:	US
Telephone Number	:	954-473-4717
Fax Number	:	954-473-9519

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY OPERATIONS
Name	:	DENISE HEFLEY
Credential	:
Telephone Number	:	954-473-4717

Provider Enumeration Date	:	02/25/2015
Last Update Date	:	06/17/2016

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Directions to “DIABETIC CARE RX LLC ” Practice Location

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