Provider Demographics
NPI:1386186443
Name:DAVIE PILL BOX LLC
Entity Type:Organization
Organization Name:DAVIE PILL BOX LLC
Other - Org Name:PILL BOX PHARMACY DAVIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-475-7455
Mailing Address - Street 1:7701 NOVA DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-5833
Mailing Address - Country:US
Mailing Address - Phone:954-475-7455
Mailing Address - Fax:954-475-7031
Practice Address - Street 1:7701 NOVA DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5833
Practice Address - Country:US
Practice Address - Phone:954-475-7455
Practice Address - Fax:954-475-7031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 333600000X, 3336C0003X
FLPH304363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166136OtherPK