MEDICARE: STAYWELL PHARMACY & MEDICAL SUPPLY

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	332B00000X	Durable Medical Equipment & Medical Supplies		FL

General Provider Information

NPI Number	:	1851844732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAYWELL PHARMACY & MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	5820 STIRLING RD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-1527
Country	:	US
Telephone Number	:	954-309-6836
Fax Number	:

Provider Business Practice Location Address
First Line	:	5820 STIRLING RD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-1527
Country	:	US
Telephone Number	:	954-309-6836
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FRANCISCO A MARCOLINO
Credential	:
Telephone Number	:	954-309-6836

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	07/27/2016

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