Provider Demographics
NPI:1154507564
Name:CHEM RX OF BOCA RATON LLC
Entity Type:Organization
Organization Name:CHEM RX OF BOCA RATON LLC
Other - Org Name:CHEM RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANG
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-426-9322
Mailing Address - Street 1:5001 NW 13TH AVE
Mailing Address - Street 2:STE H AND I
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-8649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5001 NW 13TH AVE
Practice Address - Street 2:STE H AND I
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-8649
Practice Address - Country:US
Practice Address - Phone:954-426-9322
Practice Address - Fax:954-426-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
FLPH231343336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1031664OtherOTHER ID NUMBER