Organization
MED 1ST LLC
Active
Other names
MED 1ST
Organization subpart
No
Provider details
NPI number
Authorized official
TERENCE WILLIAMS (CO OWNER)
(727) 375-9898
Entity
Organization
Contact information
Practice address
11206 CHALLENGER AVE, UNIT D, ODESSA, FL 33556-3482
(727) 375-9898
(727) 375-9870
Mailing address
11206 CHALLENGER AVE, UNIT D, ODESSA, FL 33556-3482
(727) 375-9898
(727) 375-9870
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
Primary
PH22474
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1025370
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/06/2007
Last updated
08/31/2009
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