Provider Demographics
NPI:1689381097
Name:STARK MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:STARK MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACARTI
Authorized Official - Middle Name:J
Authorized Official - Last Name:LABRADOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-779-7898
Mailing Address - Street 1:2880 W OAKLAND PARK BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-1362
Mailing Address - Country:US
Mailing Address - Phone:754-779-7898
Mailing Address - Fax:
Practice Address - Street 1:2880 W OAKLAND PARK BLVD STE 107
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33311-1362
Practice Address - Country:US
Practice Address - Phone:754-779-7898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies