Provider Demographics
NPI:1417026709
Name:SUPERIOR MEDICAL SUPPLY
Entity Type:Organization
Organization Name:SUPERIOR MEDICAL SUPPLY
Other - Org Name:SUPERIOR PHARMACY & DISCOUNT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEDYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GESSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-312-4868
Mailing Address - Street 1:7264 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4654
Mailing Address - Country:US
Mailing Address - Phone:786-312-4868
Mailing Address - Fax:305-262-5644
Practice Address - Street 1:7264 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4654
Practice Address - Country:US
Practice Address - Phone:786-312-4868
Practice Address - Fax:305-262-5644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH220603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5420350001Medicare ID - Type UnspecifiedPROVIDE NUMBER