Provider Demographics
NPI:1992848378
Name:SUNCOAST PHARMACY OF BOYNTON BEACH
Entity Type:Organization
Organization Name:SUNCOAST PHARMACY OF BOYNTON BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:FINNERAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-477-9622
Mailing Address - Street 1:1200 S ROGERS CIR
Mailing Address - Street 2:UNIT 9
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-5703
Mailing Address - Country:US
Mailing Address - Phone:561-477-9622
Mailing Address - Fax:561-488-9764
Practice Address - Street 1:8280 JOG RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-2938
Practice Address - Country:US
Practice Address - Phone:561-733-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313217332B00000X
332BP3500X
FLORF73335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLORF73OtherORTHOITC FITTER
FL1313217OtherDME LICENSE
FL4067490007Medicare ID - Type Unspecified