Provider Demographics
NPI:1376795740
Name:MY PHARMACY INC
Entity Type:Organization
Organization Name:MY PHARMACY INC
Other - Org Name:PALMETTO BAY HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC TRES
Authorized Official - Prefix:MR
Authorized Official - First Name:BERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-238-2478
Mailing Address - Street 1:14989 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7929
Mailing Address - Country:US
Mailing Address - Phone:305-238-2478
Mailing Address - Fax:305-238-0261
Practice Address - Street 1:14989 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7929
Practice Address - Country:US
Practice Address - Phone:305-238-2478
Practice Address - Fax:305-238-0261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0443810001Medicare NSC