Provider Demographics
NPI:1417978479
Name:DIABETIC CARE RX LLC
Entity Type:Organization
Organization Name:DIABETIC CARE RX LLC
Other - Org Name:PATIENT CARE AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEFLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:866-348-0441
Mailing Address - Street 1:3890 PARK CENTRAL BLVD N
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-2264
Mailing Address - Country:US
Mailing Address - Phone:866-348-0441
Mailing Address - Fax:888-443-5034
Practice Address - Street 1:3890 PARK CENTRAL BLVD N
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-2264
Practice Address - Country:US
Practice Address - Phone:866-348-0441
Practice Address - Fax:888-443-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH22190332B00000X
332BP3500X, 333600000X, 3336C0003X, 3336C0004X, 3336H0001X, 3336M0002X, 3336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031604100Medicaid
2006491OtherPK
FL031604100Medicaid