MEDICARE: BOYETTE ENTERPRISES LLC

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

General Provider Information

NPI Number	:	1710534086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOYETTE ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	1200 WITCHDUCK BAY CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-5621
Country	:	US
Telephone Number	:	757-567-0798
Fax Number	:	757-366-2252

Provider Business Practice Location Address
First Line	:	3852 VIRGINIA BEACH BLVD UNIT B
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-2489
Country	:	US
Telephone Number	:	757-567-0798
Fax Number	:	757-366-2252

Authorized Official
Title or Position	:	EXECUTIVE OFFICER
Name	:	JESSICA CRAVEN
Credential	:
Telephone Number	:	757-968-6200

Provider Enumeration Date	:	08/21/2019
Last Update Date	:	08/21/2019

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Directions to “BOYETTE ENTERPRISES LLC ” Practice Location

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