Provider Demographics
NPI:1942522180
Name:DIRECT MEDS OF FLORIDA LLC
Entity Type:Organization
Organization Name:DIRECT MEDS OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-454-8118
Mailing Address - Street 1:800 E HALLANDALE BEACH BLVD STE 18
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4476
Mailing Address - Country:US
Mailing Address - Phone:954-454-8118
Mailing Address - Fax:954-454-9898
Practice Address - Street 1:800 E HALLANDALE BEACH BLVD STE 18
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4476
Practice Address - Country:US
Practice Address - Phone:954-454-8118
Practice Address - Fax:954-454-9898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
FLPH244593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001911100Medicaid
2123855OtherPK
FL001911101Medicaid