Provider Demographics
NPI:1427169440
Name:DMD PHARMACY SERVICES LLC
Entity type:Organization
Organization Name:DMD PHARMACY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMBRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-682-9400
Mailing Address - Street 1:2386 NW 49TH LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 CENTURY VILLAGE BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417
Practice Address - Country:US
Practice Address - Phone:561-682-9400
Practice Address - Fax:561-681-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPH189693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026094100Medicaid
1097725OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4727220001Medicare NSC