Provider Demographics
NPI:1598854143
Name:BOCA PHARMACY INC
Entity Type:Organization
Organization Name:BOCA PHARMACY INC
Other - Org Name:BOCA PHARMPAC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMB
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:561-368-6161
Mailing Address - Street 1:5458 TOWN CENTER RD
Mailing Address - Street 2:STE 7
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1089
Mailing Address - Country:US
Mailing Address - Phone:561-393-6778
Mailing Address - Fax:561-393-7650
Practice Address - Street 1:5458 TOWN CENTER RD
Practice Address - Street 2:STE 7
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1089
Practice Address - Country:US
Practice Address - Phone:561-393-6778
Practice Address - Fax:561-393-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH114423336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL212557900Medicaid
1077836OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0859510001Medicare NSC