Provider Demographics
NPI:1629383278
Name:BAM HEALTHCARE ABERDEEN LLC
Entity Type:Organization
Organization Name:BAM HEALTHCARE ABERDEEN LLC
Other - Org Name:ABERDEEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-734-8010
Mailing Address - Street 1:8276 S JOG RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-2938
Mailing Address - Country:US
Mailing Address - Phone:561-734-8010
Mailing Address - Fax:561-734-8032
Practice Address - Street 1:8276 S JOG RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2938
Practice Address - Country:US
Practice Address - Phone:561-734-8010
Practice Address - Fax:561-734-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336C0004X
FLPH247893336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126136OtherPK