Provider Demographics
NPI:1265443022
Name:RASPBERRY MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:RASPBERRY MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-517-1323
Mailing Address - Street 1:149 WEST PLAZA (2700 NW 79ST)
Mailing Address - Street 2:233
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-4731
Mailing Address - Country:US
Mailing Address - Phone:786-517-1323
Mailing Address - Fax:786-517-1323
Practice Address - Street 1:149 WEST PLZ
Practice Address - Street 2:SUITE 233
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-4731
Practice Address - Country:US
Practice Address - Phone:786-517-1323
Practice Address - Fax:786-517-1323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5760320001Medicare NSC