MEDICARE: BLACKBIRD PHARMACY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3336H0001X	Home Infusion Therapy Pharmacy
2	3336S0011X	Specialty Pharmacy
3	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1093649527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLACKBIRD PHARMACY, LLC

Provider Business Mailing Address
First Line	:	9878 CLINT MOORE RD STE 206
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-1037
Country	:	US
Telephone Number	:	401-249-1963
Fax Number	:

Provider Business Practice Location Address
First Line	:	9878 CLINT MOORE RD STE 206
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33496-1037
Country	:	US
Telephone Number	:	401-249-1963
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID C HUGHES
Credential	:	PHARMD
Telephone Number	:	401-249-1963

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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