Provider Demographics
NPI:1013309293
Name:DIABETIC CARE RX LLC
Entity Type:Organization
Organization Name:DIABETIC CARE RX LLC
Other - Org Name:PATIENT CARE AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEFLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-473-4717
Mailing Address - Street 1:3890 PARK CENTRAL BLVD N
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-2264
Mailing Address - Country:US
Mailing Address - Phone:954-473-4717
Mailing Address - Fax:954-473-9519
Practice Address - Street 1:3890 PARK CENTRAL BLVD N
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-2264
Practice Address - Country:US
Practice Address - Phone:954-473-4717
Practice Address - Fax:954-473-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0003X, 3336C0004X, 3336H0001X
FLPH221903336S0011X
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
2150528OtherPK
5708180001Medicare NSC