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General NPI Number Information
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NPI Number | 1841514460
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Entity Type | Organization
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Legal Business Name | DIVINE PHARMACY AND HEALTHCARE LLC
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Dates
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Enumeration Date | 03/25/2010
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Last Update Date | 03/25/2010
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Provider Practice Location Address
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Address Line | 6266 S CONGRESS AVE L-12
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City | LANTANA
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State | FL
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Zip | 33462-2375
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Country | US
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Telephone | 561-420-6438
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Fax |
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Provider Business Mailing Address
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Address Line | 9326 PLANTATION ESTATES DR
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-4557
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Country | US
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Telephone | 786-306-8898
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | DR. ANTHONIA OGBANUFE
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Credential | PHARM D
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Telephone | 786-306-8898
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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 |
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License Number State |
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