Healthcare Provider Details

I. General information

NPI: 1912328717
Provider Name (Legal Business Name): BRIOVARX OF FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9994 PREMIER PKWY
MIRAMAR FL
33025-3209
US

IV. Provider business mailing address

BRIOVARX PHARMACY PO BOX 848119
LOS ANGELES CA
90084-8119
US

V. Phone/Fax

Practice location:
  • Phone: 855-438-4510
  • Fax: 954-443-9654
Mailing address:
  • Phone: 877-889-6358
  • Fax: 760-936-0669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID OBERG
Title or Position: VICE PRESIDENT, COMPLIANCE
Credential:
Phone: 949-988-5893