Healthcare Provider Details

I. General information

NPI: 1093649527
Provider Name (Legal Business Name): BLACKBIRD PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9878 CLINT MOORE RD STE 206
BOCA RATON FL
33496-1037
US

IV. Provider business mailing address

9878 CLINT MOORE RD STE 206
BOCA RATON FL
33496-1037
US

V. Phone/Fax

Practice location:
  • Phone: 401-249-1963
  • Fax:
Mailing address:
  • Phone: 401-249-1963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID C HUGHES
Title or Position: OWNER
Credential: PHARMD
Phone: 401-249-1963