1023016318 NPI number — DMD PHARMACY SERVICES,LLC

Table of content: TAKISHA RENA LANKSTER LPC (NPI 1285483933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023016318 NPI number — DMD PHARMACY SERVICES,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DMD PHARMACY SERVICES,LLC
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:
Provider Other Organization Name Type Code:
6
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:
1023016318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10401 NW 53RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33351-8014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-944-4104
Provider Business Mailing Address Fax Number:
954-572-1622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 WEST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEERFIELD BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33442-2085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-426-9899
Provider Business Practice Location Address Fax Number:
954-418-9989
Provider Enumeration Date:
07/11/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MANOS
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CONTRACT ADMINISTARTOR
Authorized Official Telephone Number:
954-944-4104

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PH19200 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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