NPIMap

Organization Active NPI

Polynesia Inc

Doing business as Clint Moore Pharmacy LTC

  • Long Term Care Pharmacy
  • Boca Raton, FL
National Provider Identifier
1205567104
Registry record updated Sep 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
Legal business name
POLYNESIA INC
Doing business as
Clint Moore Pharmacy LTC
Practice address
1906 Clint Moore Rd Ste 4
Boca Raton, FL 33496-2663
Phone
(561) 245-6985
Fax
(561) 237-8045
NPI assigned
Jun 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Yushuva
Title
President
Phone
(561) 245-6985

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Pharmacy 3336L0003X Primary

Addresses

Primary practice location

1906 Clint Moore Rd Ste 4
Boca Raton, FL 33496-2663

Mailing address

1906 Clint Moore Rd Ste 4
Boca Raton, FL 33496-2663
Phone (561) 245-6985

Other names 1

  • Clint Moore Pharmacy LTC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Clint Moore Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663459200000",
    "number": "1205567104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1906 CLINT MOORE RD STE 4",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334962663",
            "telephone_number": "561-245-6985",
            "fax_number": "561-237-8045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906 CLINT MOORE RD STE 4",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334962663",
            "telephone_number": "561-245-6985",
            "fax_number": "561-237-8045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLYNESIA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-21",
        "last_updated": "2022-09-18",
        "certification_date": "2022-09-18",
        "status": "A",
        "authorized_official_last_name": "YUSHUVA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-245-6985"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clint Moore Pharmacy LTC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clint Moore Pharmacy LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boca Raton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.