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NPI Code Detail

MEDICARE: JOHN VAN

MEDICARE: JOHN VAN
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
1183500000XPharmacistPS49372FL

General Provider Information

NPI Number : 1467799411
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN VAN
Provider Business Mailing Address
First Line : 9846 GLADES RD
Second Line :
City : BOCA RATON
State : FL
Zip : 33434-3917
Country : US
Telephone Number : 561-852-5603
Fax Number :
Provider Business Practice Location Address
First Line : 9846 GLADES RD
Second Line :
City : BOCA RATON
State : FL
Zip : 33434-3917
Country : US
Telephone Number : 561-310-8103
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2013
Last Update Date : 01/10/2013

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