1154507564 NPI number — CHEM RX OF BOCA RATON LLC

Table of content: (NPI 1154507564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154507564 NPI number — CHEM RX OF BOCA RATON LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEM RX OF BOCA RATON LLC
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:
1154507564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5001 NW 13TH AVE
Provider Second Line Business Mailing Address:
STE H AND I
Provider Business Mailing Address City Name:
POMPANO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33064-8649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5001 NW 13TH AVE
Provider Second Line Business Practice Location Address:
STE H AND I
Provider Business Practice Location Address City Name:
POMPANO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33064-8649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-426-9322
Provider Business Practice Location Address Fax Number:
954-426-9377
Provider Enumeration Date:
01/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PROTAS
Authorized Official First Name:
IRA
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANG
Authorized Official Telephone Number:
954-426-9322

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: PH23134 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1031664 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".




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