1912328717 NPI number — BRIOVARX OF FLORIDA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912328717 NPI number — BRIOVARX OF FLORIDA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIOVARX OF FLORIDA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912328717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BRIOVARX PHARMACY
Provider Second Line Business Mailing Address:
PO BOX 848119
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90084-8119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-889-6358
Provider Business Mailing Address Fax Number:
760-936-0669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9994 PREMIER PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIRAMAR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33025-3209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-438-4510
Provider Business Practice Location Address Fax Number:
954-443-9654
Provider Enumeration Date:
12/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
OBERG
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT, COMPLIANCE
Authorized Official Telephone Number:
949-988-5893

Provider Taxonomy Codes

  • Taxonomy code: 3336M0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2143582 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: PH18917 . This is a "RESIDENT STATE PHARMACY LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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