Provider Demographics
NPI:1568770048
Name:RX OF BOCA
Entity Type:Organization
Organization Name:RX OF BOCA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:561-999-2100
Mailing Address - Street 1:5801 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-4049
Mailing Address - Country:US
Mailing Address - Phone:561-999-2100
Mailing Address - Fax:561-999-4332
Practice Address - Street 1:5801 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-4049
Practice Address - Country:US
Practice Address - Phone:561-999-2100
Practice Address - Fax:561-999-4332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS18414183500000X
FLPH253843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFR2885979OtherDEA