Healthcare Provider Details

I. General information

NPI: 1629383278
Provider Name (Legal Business Name): BAM HEALTHCARE ABERDEEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8276 S JOG RD
BOYNTON BEACH FL
33472-2938
US

IV. Provider business mailing address

8276 S JOG RD
BOYNTON BEACH FL
33472-2938
US

V. Phone/Fax

Practice location:
  • Phone: 561-734-8010
  • Fax: 561-734-8032
Mailing address:
  • Phone: 561-734-8010
  • Fax: 561-734-8032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24789
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBIN WIDROFF
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 561-734-8010