Provider Demographics
NPI:1912636804
Name:OMNICARE MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:OMNICARE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:NARCISO
Authorized Official - Last Name:FERNANDEZ CONSUEGRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-487-9879
Mailing Address - Street 1:1500 N UNIVERSITY DR STE 247
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6073
Mailing Address - Country:US
Mailing Address - Phone:800-983-2618
Mailing Address - Fax:954-323-2908
Practice Address - Street 1:1500 N UNIVERSITY DR STE 247
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6073
Practice Address - Country:US
Practice Address - Phone:800-983-2618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment