Healthcare Provider Details

I. General information

NPI: 1457215139
Provider Name (Legal Business Name): CRAIG BOSCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11012 N WILLIAMS ST
DUNNELLON FL
34432-8319
US

IV. Provider business mailing address

1220 SE 46TH ST
OCALA FL
34480-4716
US

V. Phone/Fax

Practice location:
  • Phone: 352-489-4241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS69945
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: