Provider Demographics
NPI:1871749671
Name:LURD'S INC
Entity type:Organization
Organization Name:LURD'S INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DME OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARDI
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN RENSBURG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:727-697-1090
Mailing Address - Street 1:6551 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6868
Mailing Address - Country:US
Mailing Address - Phone:727-494-7646
Mailing Address - Fax:727-807-6021
Practice Address - Street 1:401 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3802
Practice Address - Country:US
Practice Address - Phone:727-803-6945
Practice Address - Fax:727-803-6947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH234913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00587400Medicaid
2116817OtherPK