Provider Demographics
NPI:1639677008
Name:UNIFIED MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:UNIFIED MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-323-7724
Mailing Address - Street 1:1293 N UNIVERSITY DR # 346
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8315
Mailing Address - Country:US
Mailing Address - Phone:561-323-7724
Mailing Address - Fax:
Practice Address - Street 1:1293 N UNIVERSITY DR # 346
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8315
Practice Address - Country:US
Practice Address - Phone:561-323-7724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies