Provider Demographics
NPI:1194164822
Name:MILES-HIBBERT, BRODERICK XAVIER (PHARM D)
Entity type:Individual
Prefix:DR
First Name:BRODERICK
Middle Name:XAVIER
Last Name:MILES-HIBBERT
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9837 COBBLESTONE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-4453
Mailing Address - Country:US
Mailing Address - Phone:561-509-7983
Mailing Address - Fax:
Practice Address - Street 1:10951 S JOG RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3921
Practice Address - Country:US
Practice Address - Phone:561-734-6848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-15
Last Update Date:2013-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist