Provider Demographics
NPI:1508877028
Name:BOYDS PHARMACY OF FLORENCE INC
Entity Type:Organization
Organization Name:BOYDS PHARMACY OF FLORENCE INC
Other - Org Name:BOYDS PHARMACY OF FLORENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:609-499-0100
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:08518-0001
Mailing Address - Country:US
Mailing Address - Phone:609-499-0100
Mailing Address - Fax:609-499-9628
Practice Address - Street 1:306 BROAD ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:NJ
Practice Address - Zip Code:08518-1912
Practice Address - Country:US
Practice Address - Phone:609-499-0100
Practice Address - Fax:609-499-9628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NJ28RS005476003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2054433OtherPK
NJ7902701Medicaid
NJ1198910001Medicare NSC