# CMB-1 RETAILER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538488606
- **Authorized official:** MR. CLINTON GEORGE BRYCE SR. (OWNER)
- **Authorized official phone:** (863) 678-4808

## Contact information

- **Practice address:** 1970 STATE ROAD 60 E, LAKE WALES, FL 33853-4369
- **Practice address phone:** (863) 678-4808
- **Mailing address:** 3661 JAPONICA AVE, INDIAN LAKE ESTATES, FL 33855
- **Mailing address phone:** (863) 692-9189

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 440000 | FL | Yes |

## Other

- **Enumeration date:** 05/27/2010
- **Last updated:** 05/27/2010