Provider Demographics
NPI:1285018234
Name:SKYEMED, INC
Entity Type:Organization
Organization Name:SKYEMED, INC
Other - Org Name:SKYEMED PHARMACY AND INFUSION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:RANADE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:866-778-8255
Mailing Address - Street 1:1332 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-3730
Mailing Address - Country:US
Mailing Address - Phone:866-778-8255
Mailing Address - Fax:800-432-6614
Practice Address - Street 1:1332 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3730
Practice Address - Country:US
Practice Address - Phone:866-778-8255
Practice Address - Fax:800-432-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH171693336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1089211OtherNCPDP
FLPH17169OtherPHARMACY LICENSE
FL21784100Medicaid
FL21784100Medicaid