Individual
CHAD DEETJEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9940 YAMATO RD, BOCA RATON, FL 33434-5538
(561) 488-9838
Mailing address
9940 YAMATO RD, BOCA RATON, FL 33434-5538
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS55234
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PS55234
LICENSE NUMBER
FL
Enumeration date
11/25/2020
Last updated
11/25/2020
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