MEDICARE: OMNICARE MEDICAL SUPPLY 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	332BC3200X	Customized Equipment (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1912636804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNICARE MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	1500 N UNIVERSITY DR STE 247
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6073
Country	:	US
Telephone Number	:	800-983-2618
Fax Number	:	954-323-2908

Provider Business Practice Location Address
First Line	:	1500 N UNIVERSITY DR STE 247
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6073
Country	:	US
Telephone Number	:	800-983-2618
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDUARDO NARCISO FERNANDEZ CONSUEGRA
Credential	:
Telephone Number	:	954-487-9879

Provider Enumeration Date	:	06/07/2022
Last Update Date	:	04/27/2023

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