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General NPI Number Information
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NPI Number | 1063991503
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Entity Type | Organization
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Legal Business Name | BBAJ LLC
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 8340 LAKEWOOD RANCH BLVD STE 105
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-5183
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Country | US
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Telephone | 304-479-4274
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Fax |
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Provider Business Mailing Address
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Address Line | 8340 LAKEWOOD RANCH BLVD STE 105
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-5183
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Country | US
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Telephone | 304-479-4274
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | BRADLEY LAHR
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Credential |
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Telephone | 304-479-4274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH31580
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License Number State | FL
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