Provider Demographics
NPI:1407075716
Name:PHARMO-MEDICAL INTERNATIONAL INC
Entity Type:Organization
Organization Name:PHARMO-MEDICAL INTERNATIONAL INC
Other - Org Name:OMEGA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-279-9999
Mailing Address - Street 1:9537 SW 72ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3247
Mailing Address - Country:US
Mailing Address - Phone:305-279-9999
Mailing Address - Fax:305-279-1277
Practice Address - Street 1:9537 SW 72ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3247
Practice Address - Country:US
Practice Address - Phone:305-279-9999
Practice Address - Fax:305-279-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH77243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2006182OtherPK
FL104711600Medicaid
1042201OtherOTHER ID NUMBER
FL1047116001OtherMEDICAID DME