Organization
LIFESTORE MEDICAL SUPPLY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE GODWIN (MMBR)
(561) 953-1200
Entity
Organization
Contact information
Practice address
5255 N FEDERAL HWY, BOCA RATON, FL 33487-4901
(561) 953-1200
(561) 241-6160
Mailing address
5255 N FEDERAL HWY, BOCA RATON, FL 33487-4901
(561) 953-1200
(561) 241-6160
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
11/29/2010
Last updated
11/29/2010
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