Provider Demographics
NPI:1609161413
Name:BOVA, IVETTE D (PHARMD)
Entity Type:Individual
Prefix:
First Name:IVETTE
Middle Name:D
Last Name:BOVA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HOLLYWOOD MALL
Mailing Address - Street 2:T0877
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6904
Mailing Address - Country:US
Mailing Address - Phone:954-962-5373
Mailing Address - Fax:954-962-5373
Practice Address - Street 1:300 HOLLYWOOD MALL
Practice Address - Street 2:T0877
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6904
Practice Address - Country:US
Practice Address - Phone:954-962-5373
Practice Address - Fax:954-962-5373
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist