Provider Demographics
NPI:1871579375
Name:MEDICAL TECHNOLOGY TRANSFER CORPORATION
Entity type:Organization
Organization Name:MEDICAL TECHNOLOGY TRANSFER CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:321-726-1614
Mailing Address - Street 1:1800 W HIBISCUS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2629
Mailing Address - Country:US
Mailing Address - Phone:321-726-1614
Mailing Address - Fax:321-726-1611
Practice Address - Street 1:1800 W HIBISCUS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2629
Practice Address - Country:US
Practice Address - Phone:321-726-1614
Practice Address - Fax:321-726-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH15653333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy