Provider Demographics
NPI:1659830487
Name:NEW LIFE PHARMACY & MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:NEW LIFE PHARMACY & MEDICAL SUPPLY INC
Other - Org Name:NEW LIFE PHARMACY & MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:772-877-1125
Mailing Address - Street 1:11200 SW VILLAGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2383
Mailing Address - Country:US
Mailing Address - Phone:772-877-1125
Mailing Address - Fax:772-800-5039
Practice Address - Street 1:11200 SW VILLAGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2383
Practice Address - Country:US
Practice Address - Phone:772-877-1125
Practice Address - Fax:772-800-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies