Provider Demographics
NPI:1710534086
Name:BOYETTE ENTERPRISES LLC
Entity Type:Organization
Organization Name:BOYETTE ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-968-6200
Mailing Address - Street 1:1200 WITCHDUCK BAY CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5621
Mailing Address - Country:US
Mailing Address - Phone:757-567-0798
Mailing Address - Fax:757-366-2252
Practice Address - Street 1:3852 VIRGINIA BEACH BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-2489
Practice Address - Country:US
Practice Address - Phone:757-567-0798
Practice Address - Fax:757-366-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty