Provider Demographics
NPI:1578564159
Name:BOOSE, ALBERT CHARLES (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:CHARLES
Last Name:BOOSE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11411 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6624
Mailing Address - Country:US
Mailing Address - Phone:954-436-9724
Mailing Address - Fax:
Practice Address - Street 1:11411 SW 21ST ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6624
Practice Address - Country:US
Practice Address - Phone:954-436-9724
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS17780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist