Provider Demographics
NPI:1851437461
Name:DANIA REXALL PHCY AND MED SUPPLY
Entity Type:Organization
Organization Name:DANIA REXALL PHCY AND MED SUPPLY
Other - Org Name:DANIA REXALL PHARMACY & MEDICAL SUPPLY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-921-4665
Mailing Address - Street 1:20-22 SOUTH FEDERAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004
Mailing Address - Country:US
Mailing Address - Phone:954-921-4665
Mailing Address - Fax:954-921-2310
Practice Address - Street 1:20-22 SOUTH FEDERAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004
Practice Address - Country:US
Practice Address - Phone:954-921-4665
Practice Address - Fax:954-921-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH00166143336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2012723OtherPK
FL009049400Medicaid