Provider Demographics
NPI:1740507136
Name:PHARMACYMAX LABS, LLC
Entity type:Organization
Organization Name:PHARMACYMAX LABS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:BELAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-715-6051
Mailing Address - Street 1:PO BOX 690519
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-0519
Mailing Address - Country:US
Mailing Address - Phone:407-354-4555
Mailing Address - Fax:407-245-2802
Practice Address - Street 1:8751 COMMODITY CIR STE 16
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9027
Practice Address - Country:US
Practice Address - Phone:407-354-4555
Practice Address - Fax:407-245-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X, 332B00000X, 333600000X
FLPH246003336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124805OtherPK