Organization
OPTIMAL HEALTH & WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELINE SAMANTHA DEMARCO PHARMD (OWNER/FUNCTIONAL MED. SPECIALIST)
(631) 300-6320
Entity
Organization
Contact information
Practice address
11140 LYNWOOD PALM WAY, PALM BEACH GARDENS, FL 33412-2470
(631) 300-6320
(954) 208-0066
Mailing address
6 MONTROSE DR, COMMACK, NY 11725-1313
(631) 300-6320
(954) 208-0066
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
—
—
261QC1800X
Corporate Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
335G00000X
Medical Foods Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L21000465958
ARTICLES OF ORGANIZATION FOR LLC
FL
Enumeration date
11/30/2021
Last updated
11/30/2021
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