Provider Demographics
NPI:1174645477
Name:MED 1ST LLC
Entity Type:Organization
Organization Name:MED 1ST LLC
Other - Org Name:MED 1ST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-375-9898
Mailing Address - Street 1:11206 CHALLENGER AVE
Mailing Address - Street 2:UNIT D
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3482
Mailing Address - Country:US
Mailing Address - Phone:727-375-9898
Mailing Address - Fax:727-375-9870
Practice Address - Street 1:11206 CHALLENGER AVE
Practice Address - Street 2:UNIT D
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-3482
Practice Address - Country:US
Practice Address - Phone:727-375-9898
Practice Address - Fax:727-375-9870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
FLPH224743336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1025370OtherNCPDP PROVIDER IDENTIFICATION NUMBER