Provider Demographics
NPI:1083217798
Name:HTOON-BOEHME, MICHELLE YADANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:YADANA
Last Name:HTOON-BOEHME
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CROOKED RUN PLZ
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-7004
Mailing Address - Country:US
Mailing Address - Phone:540-631-3291
Mailing Address - Fax:
Practice Address - Street 1:10 CROOKED RUN PLZ
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-7004
Practice Address - Country:US
Practice Address - Phone:540-631-3291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202214410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist