Provider Demographics
NPI:1841514460
Name:DIVINE PHARMACY AND HEALTHCARE LLC
Entity type:Organization
Organization Name:DIVINE PHARMACY AND HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBANUFE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:786-306-8898
Mailing Address - Street 1:9326 PLANTATION ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4557
Mailing Address - Country:US
Mailing Address - Phone:786-306-8898
Mailing Address - Fax:
Practice Address - Street 1:6266 S CONGRESS AVE
Practice Address - Street 2:L-12
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-2375
Practice Address - Country:US
Practice Address - Phone:561-420-6438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy