ABACOA MEDICAL SUPPLIES INC

Provider Demographics

• NPI: 1619465689
• Name: ABACOA MEDICAL SUPPLIES INC
• Entity Type: Organization
• Organization Name: ABACOA MEDICAL SUPPLIES INC
• Other - Org Name: ABACOA MEDICAL SUPPLIES, INC.
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - First Name: LAWRENCE
• Authorized Official - Middle Name: A
• Authorized Official - Last Name: DICKSON
• Authorized Official - Phone: 561-994-2302
• Mailing Address - Street 1: 3100 NW BOCA RATON BLVD STE 213
• Mailing Address - City: BOCA RATON
• Mailing Address - State: FL
• Mailing Address - Zip Code: 33431-6658
• Mailing Address - Country: US
• Mailing Address - Phone: 561-994-2302
• Mailing Address - Fax: 888-204-4514
• Practice Address - Street 1: 3100 NW BOCA RATON BLVD STE 213
• Practice Address - City: BOCA RATON
• Practice Address - State: FL
• Practice Address - Zip Code: 33431-6658
• Practice Address - Country: US
• Practice Address - Phone: 561-994-2302
• Practice Address - Fax: 888-204-4514
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2018-04-25
• Last Update Date: 2024-05-15

Provider Licenses

State	License ID	Taxonomies
FL	2018106632	332B00000X
		332B00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies

Provider Identifiers

State	Identifier ID	ID Type	Issuer
	2177429	Other	PK
LA	2483871	Medicaid
SC	DM1616	Medicaid
OR	NPC-0004670	Other	BOARD OF PHARMACY
NE	10026761200	Medicaid
IN	300019499	Medicaid
OR	500758565	Medicaid
DC	067848214	Medicaid
NJ	0698636	Medicaid
ND	1480327	Medicaid
OK	200806460A	Medicaid
AZ	435148	Medicaid
NM	53407334	Medicaid
VT	6710681	Medicaid
KY	7100570080	Medicaid
CO	900017037	Medicaid
OH	0393111	Medicaid
FL	101491800	Medicaid
WY	151768600	Medicaid
DE	250572523	Medicaid
MD	282023400	Medicaid
TX	396703601	Medicaid
HI	006887	Medicaid
WI	100092814	Medicaid
WA	2124621	Medicaid
AR	234796741	Medicaid
	5737727	Other	NCPDP
CA	937133	Medicaid
MS	006058509	Medicaid
MO	620065893	Medicaid
SD	3002474	Medicaid
GA	003227252A	Medicaid
PA	1036577000001	Medicaid
AL	225119	Medicaid
KS	30004619230001	Medicaid
TN	Q047492	Medicaid