Provider Demographics
NPI:1174995161
Name:NMB GENERICS INC
Entity type:Organization
Organization Name:NMB GENERICS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-974-4510
Mailing Address - Street 1:117 W MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-1328
Mailing Address - Country:US
Mailing Address - Phone:217-697-5533
Mailing Address - Fax:800-830-1813
Practice Address - Street 1:16600 N MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-6026
Practice Address - Country:US
Practice Address - Phone:305-974-4510
Practice Address - Fax:305-454-9748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH247303336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003506400Medicaid
2155003OtherPK