Provider Demographics
NPI:1174143358
Name:BOHAN, THOMAS ANTHONY
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANTHONY
Last Name:BOHAN
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 1:9761 RIDGE WALK CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-7140
Mailing Address - Country:US
Mailing Address - Phone:954-650-4424
Mailing Address - Fax:
Practice Address - Street 1:7701 NOVA DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5833
Practice Address - Country:US
Practice Address - Phone:954-475-7455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-17
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS294121835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist