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General NPI Number Information
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NPI Number | 1205567104
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Entity Type | Organization
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Legal Business Name | POLYNESIA INC
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Dates
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Enumeration Date | 06/21/2022
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Last Update Date | 09/18/2022
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Provider Practice Location Address
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Address Line | 1906 CLINT MOORE RD STE 4
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City | BOCA RATON
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State | FL
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Zip | 33496-2663
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Country | US
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Telephone | 561-245-6985
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Fax | 561-237-8045
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Provider Business Mailing Address
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Address Line | 1906 CLINT MOORE RD STE 4
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City | BOCA RATON
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State | FL
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Zip | 33496-2663
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Country | US
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Telephone | 561-245-6985
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Fax | 561-237-8045
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL YUSHUVA
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Credential |
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Telephone | 561-245-6985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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