Provider Demographics
NPI:1750665105
Name:BOCA DRUGS INC
Entity type:Organization
Organization Name:BOCA DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MGR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DESIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-298-1961
Mailing Address - Street 1:156 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7949
Mailing Address - Country:US
Mailing Address - Phone:561-395-8663
Mailing Address - Fax:561-395-8664
Practice Address - Street 1:156 NW 20TH ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7949
Practice Address - Country:US
Practice Address - Phone:561-395-8663
Practice Address - Fax:561-395-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH252003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5707697OtherNCPDP PROVIDER IDENTIFICATION NUMBER