# MED 1ST LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MED 1ST
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174645477
- **Authorized official:** TERENCE WILLIAMS (CO OWNER)
- **Authorized official phone:** (727) 375-9898

## Contact information

- **Practice address:** 11206 CHALLENGER AVE, UNIT D, ODESSA, FL 33556-3482
- **Practice address phone:** (727) 375-9898
- **Practice address fax:** (727) 375-9870
- **Mailing address:** 11206 CHALLENGER AVE, UNIT D, ODESSA, FL 33556-3482
- **Mailing address phone:** (727) 375-9898
- **Mailing address fax:** (727) 375-9870

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336M0003X | Managed Care Organization Pharmacy | PH22474 | FL | Yes |

## Other

- **Enumeration date:** 04/06/2007
- **Last updated:** 08/31/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1025370 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |