Healthcare Provider Details

I. General information

NPI: 1013236504
Provider Name (Legal Business Name): JUSTUS BOSHOFF B.SC., B.PHARM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2010
Last Update Date: 05/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37950 47TH ST E
PALMDALE CA
93552-3271
US

IV. Provider business mailing address

41545 44TH ST W
LANCASTER CA
93536-2494
US

V. Phone/Fax

Practice location:
  • Phone: 661-285-9473
  • Fax: 661-285-5040
Mailing address:
  • Phone: 661-579-9166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: