Healthcare Provider Details

I. General information

NPI: 1770853293
Provider Name (Legal Business Name): MY COMMUNITY PHARMACY OF BOYNTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2012
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 GATEWAY BLVD STE 101
BOYNTON BEACH FL
33426-8363
US

IV. Provider business mailing address

1050 GATEWAY BLVD SUITE 101
BOYNTON BEACH FL
33426-8368
US

V. Phone/Fax

Practice location:
  • Phone: 561-200-4245
  • Fax: 561-200-4236
Mailing address:
  • Phone: 561-200-4245
  • Fax: 561-200-4236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH25868
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: YANA BIRBRAYER
Title or Position: PHCY OWNER/MANAGER
Credential:
Phone: 561-512-5462