Provider Demographics
NPI:1023016318
Name:DMD PHARMACY SERVICES,LLC
Entity Type:Organization
Organization Name:DMD PHARMACY SERVICES,LLC
Other - Org Name:THE VILLAGE PHARMACY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACT ADMINISTARTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-944-4104
Mailing Address - Street 1:10401 NW 53RD ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-8014
Mailing Address - Country:US
Mailing Address - Phone:954-944-4104
Mailing Address - Fax:954-572-1622
Practice Address - Street 1:3501 WEST DR
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-2085
Practice Address - Country:US
Practice Address - Phone:954-426-9899
Practice Address - Fax:954-418-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH19200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4727220002Medicare ID - Type Unspecified