Provider Demographics
NPI:1659687119
Name:DOCTOR DIABETIC PHARMACY INC
Entity Type:Organization
Organization Name:DOCTOR DIABETIC PHARMACY INC
Other - Org Name:DOCTOR DIABETIC PHARMACY, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP PHARMACY OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-829-7581
Mailing Address - Street 1:100 NE 28TH STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137
Mailing Address - Country:US
Mailing Address - Phone:888-829-7581
Mailing Address - Fax:
Practice Address - Street 1:100 NE 28TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4423
Practice Address - Country:US
Practice Address - Phone:888-829-7581
Practice Address - Fax:866-989-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH248283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5701417OtherNCPDP PROVIDER IDENTIFICATION NUMBER