Provider Demographics
NPI:1366832750
Name:BOYETTE, DANNY YANG
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:YANG
Last Name:BOYETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9902 VENETIAN RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619
Mailing Address - Country:US
Mailing Address - Phone:813-924-0719
Mailing Address - Fax:
Practice Address - Street 1:9902 VENETIAN RIVER WAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-5012
Practice Address - Country:US
Practice Address - Phone:813-924-0719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI29753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPSI29753OtherDEPARTMENT OF HEALTH