MEDICARE: MR. ALBERT CHARLES BOOSE RPH

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	PS17780	FL

General Provider Information

NPI Number	:	1578564159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALBERT CHARLES BOOSE RPH

Provider Business Mailing Address
First Line	:	11411 SW 21ST ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-6624
Country	:	US
Telephone Number	:	954-436-9724
Fax Number	:

Provider Business Practice Location Address
First Line	:	11411 SW 21ST ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-6624
Country	:	US
Telephone Number	:	954-436-9724
Fax Number	:

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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