Healthcare Provider Details

I. General information

NPI: 1003123894
Provider Name (Legal Business Name): CND4,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6083 SE FEDERAL HWY STE 107
STUART FL
34997-8104
US

IV. Provider business mailing address

3599 W WOOLBRIGHT RD
BOYNTON BEACH FL
33436-7243
US

V. Phone/Fax

Practice location:
  • Phone: 772-678-4000
  • Fax: 772-678-4001
Mailing address:
  • Phone: 561-733-1100
  • Fax: 561-733-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24844
License Number StateFL

VIII. Authorized Official

Name: NIRAV PATEL
Title or Position: VICE PRESIDENT
Credential:
Phone: 561-844-1191