Healthcare Provider Details

I. General information

NPI: 1003928359
Provider Name (Legal Business Name): DAVID H BOARDMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 NATIONAL HEALTH CARE DR D119
DAYTONA BEACH FL
32114-1495
US

IV. Provider business mailing address

3047 S ATLANTIC AVE #604
DAYTONA BEACH FL
32118-6151
US

V. Phone/Fax

Practice location:
  • Phone: 386-323-7548
  • Fax: 386-323-7593
Mailing address:
  • Phone: 386-761-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: