Provider Demographics
NPI:1821079880
Name:SKYEMED PHARMACY INC
Entity Type:Organization
Organization Name:SKYEMED PHARMACY INC
Other - Org Name:SKYEMED PHARMACY AND INFUSION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:RANADE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:954-580-0170
Mailing Address - Street 1:PO BOX 117070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-7070
Mailing Address - Country:US
Mailing Address - Phone:954-580-0170
Mailing Address - Fax:954-960-6000
Practice Address - Street 1:1332 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3730
Practice Address - Country:US
Practice Address - Phone:954-580-0170
Practice Address - Fax:954-960-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X, 3336C0004X, 3336H0001X, 3336S0011X
FLPH171693336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021784100Medicaid
FL021784101Medicaid
2013306OtherPK
1319630001Medicare NSC