Provider Demographics
NPI:1972615805
Name:DRM ENTERPRISES
Entity type:Organization
Organization Name:DRM ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKOWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-236-5953
Mailing Address - Street 1:PO BOX 2969
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33806-2969
Mailing Address - Country:US
Mailing Address - Phone:863-683-2807
Mailing Address - Fax:863-682-6298
Practice Address - Street 1:4625 N NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-4013
Practice Address - Country:US
Practice Address - Phone:813-236-5953
Practice Address - Fax:813-237-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
FLPH196173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL026205600Medicaid
1046780OtherNCPDP PROVIDER IDENTIFICATION NUMBER