Provider Demographics
NPI:1508460874
Name:BOROVICKA, DAVE A
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:A
Last Name:BOROVICKA
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 1:18351 BRICK MILL RUN
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-7149
Mailing Address - Country:US
Mailing Address - Phone:440-666-8015
Mailing Address - Fax:
Practice Address - Street 1:2007 BROOKPARK RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-5813
Practice Address - Country:US
Practice Address - Phone:216-351-2944
Practice Address - Fax:216-749-3983
Is Sole Proprietor?:No
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-19357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist