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General NPI Number Information
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NPI Number | 1710534086
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Entity Type | Organization
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Legal Business Name | BOYETTE ENTERPRISES LLC
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Dates
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Enumeration Date | 08/21/2019
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Last Update Date | 08/21/2019
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Provider Practice Location Address
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Address Line | 3852 VIRGINIA BEACH BLVD UNIT B
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-2489
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Country | US
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Telephone | 757-567-0798
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Fax | 757-366-2252
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Provider Business Mailing Address
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Address Line | 1200 WITCHDUCK BAY CT
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-5621
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Country | US
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Telephone | 757-567-0798
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Fax | 757-366-2252
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Authorized Official
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Title or Position | EXECUTIVE OFFICER
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Name | JESSICA CRAVEN
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Credential |
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Telephone | 757-968-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State |
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