Provider Demographics
NPI:1023426467
Name:BEOVICH, DOMINIC FRANK IV (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:FRANK
Last Name:BEOVICH
Suffix:IV
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-7823
Mailing Address - Country:US
Mailing Address - Phone:407-447-6546
Mailing Address - Fax:
Practice Address - Street 1:6350 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-7823
Practice Address - Country:US
Practice Address - Phone:407-447-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52198183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS52198OtherSTATE PHARMACIST LICENSE