Provider Demographics
NPI:1225049869
Name:DMD PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:DMD PHARMACY SERVICES LLC
Other - Org Name:VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMBRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-426-9899
Mailing Address - Street 1:110 CENTURY BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-2262
Mailing Address - Country:US
Mailing Address - Phone:561-615-4554
Mailing Address - Fax:561-681-9933
Practice Address - Street 1:1804 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1402
Practice Address - Country:US
Practice Address - Phone:954-426-9899
Practice Address - Fax:954-418-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPH245123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026060600Medicaid
1098664OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4727220002Medicare NSC