Provider Demographics
NPI:1285821264
Name:ADW DIABETES LLC
Entity Type:Organization
Organization Name:ADW DIABETES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:954-415-1434
Mailing Address - Street 1:2501 NW 34TH PL
Mailing Address - Street 2:STE 35
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-5928
Mailing Address - Country:US
Mailing Address - Phone:877-241-9002
Mailing Address - Fax:954-975-3786
Practice Address - Street 1:2501 NW 34TH PL
Practice Address - Street 2:SUITE 35
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-5928
Practice Address - Country:US
Practice Address - Phone:877-241-9002
Practice Address - Fax:954-975-3786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6178780001Medicare NSC