Provider Demographics
NPI:1982908497
Name:DURA-MED SOUTHEAST INC.
Entity Type:Organization
Organization Name:DURA-MED SOUTHEAST INC.
Other - Org Name:DUA-MED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-675-6850
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-0640
Mailing Address - Country:US
Mailing Address - Phone:850-675-6850
Mailing Address - Fax:850-675-6805
Practice Address - Street 1:3877 HWY 4
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565
Practice Address - Country:US
Practice Address - Phone:850-675-6850
Practice Address - Fax:850-675-6805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies