1982908497 NPI number — DURA-MED SOUTHEAST INC.

Table of content: (NPI 1982908497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982908497 NPI number — DURA-MED SOUTHEAST INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DURA-MED SOUTHEAST INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DUA-MED PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982908497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 640
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32565-0640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-675-6850
Provider Business Mailing Address Fax Number:
850-675-6805

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3877 HWY 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-675-6850
Provider Business Practice Location Address Fax Number:
850-675-6805
Provider Enumeration Date:
12/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HERRING
Authorized Official First Name:
MISTY
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERVISING PHARMACIST
Authorized Official Telephone Number:
850-675-6850

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com