Organization
MTM ON THE GO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DESHAWNDRE BRIDLEY PHARM. D. (CEO)
(407) 271-5493
Entity
Organization
Contact information
Practice address
3022 SEABROOK AVE, ORLANDO, FL 32805-6007
(407) 271-5493
Mailing address
3022 SEABROOK AVE, ORLANDO, FL 32805-6007
(407) 271-5493
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
09/19/2012
Last updated
09/19/2012
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