Provider Demographics
NPI:1013236504
Name:BOSHOFF, JUSTUS (BSC, BPHARM)
Entity type:Individual
Prefix:
First Name:JUSTUS
Middle Name:
Last Name:BOSHOFF
Suffix:
Gender:M
Credentials:BSC, BPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41545 44TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-2494
Mailing Address - Country:US
Mailing Address - Phone:661-579-9166
Mailing Address - Fax:
Practice Address - Street 1:37950 47TH ST E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-3271
Practice Address - Country:US
Practice Address - Phone:661-285-9473
Practice Address - Fax:661-285-5040
Is Sole Proprietor?:No
Enumeration Date:2010-05-23
Last Update Date:2010-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist