Provider Demographics
NPI:1114231800
Name:SUREMEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:SUREMEDICAL SERVICES LLC
Other - Org Name:RDS PHARMACY #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:AIMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ARYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-545-0533
Mailing Address - Street 1:11410 INTERCHANGE CIR N
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6005
Mailing Address - Country:US
Mailing Address - Phone:954-437-1835
Mailing Address - Fax:954-437-1775
Practice Address - Street 1:11410 INTERCHANGE CIR N
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6005
Practice Address - Country:US
Practice Address - Phone:954-437-1835
Practice Address - Fax:954-437-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
FLPH247693336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5701342OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL002936400Medicaid