Provider Demographics
NPI:1912328717
Name:BRIOVARX OF FLORIDA, INC.
Entity Type:Organization
Organization Name:BRIOVARX OF FLORIDA, INC.
Other - Org Name:BRIOVARX OF FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-988-5893
Mailing Address - Street 1:BRIOVARX PHARMACY
Mailing Address - Street 2:PO BOX 848119
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-8119
Mailing Address - Country:US
Mailing Address - Phone:877-889-6358
Mailing Address - Fax:760-936-0669
Practice Address - Street 1:9994 PREMIER PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3209
Practice Address - Country:US
Practice Address - Phone:855-438-4510
Practice Address - Fax:954-443-9654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143582OtherPK
FLPH18917OtherRESIDENT STATE PHARMACY LICENSE