Provider Demographics
NPI:1407550528
Name:ADW DIABETES LLC
Entity Type:Organization
Organization Name:ADW DIABETES LLC
Other - Org Name:ADW DIABETES PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:877-241-9002
Mailing Address - Street 1:2501 NW 34TH PL STE 35
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-5930
Mailing Address - Country:US
Mailing Address - Phone:877-241-9002
Mailing Address - Fax:954-975-3786
Practice Address - Street 1:701 MARKET ST STE 108B
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8803
Practice Address - Country:US
Practice Address - Phone:877-241-9002
Practice Address - Fax:954-975-3786
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADW DIABETES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-30
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy