Provider Demographics
NPI:1427467992
Name:BOADI, VICTOR
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:BOADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7321 NW 16TH ST
Mailing Address - Street 2:APT. A106
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-5273
Mailing Address - Country:US
Mailing Address - Phone:704-231-4193
Mailing Address - Fax:
Practice Address - Street 1:10870 OVERSEAS HIGHWAY
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050
Practice Address - Country:US
Practice Address - Phone:305-743-6929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist