MEDICARE: SHREYA BODAR

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS44343	FL

General Provider Information

NPI Number	:	1275154031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHREYA BODAR

Provider Business Mailing Address
First Line	:	9573 COBBLESTONE CREEK DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-4449
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9573 COBBLESTONE CREEK DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-4449
Country	:	US
Telephone Number	:	561-523-6906
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2020
Last Update Date	:	05/04/2020

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