Provider Demographics
NPI:1144215658
Name:BOYD, TWILA DIANE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TWILA
Middle Name:DIANE
Last Name:BOYD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX C
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:OH
Mailing Address - Zip Code:45368-0803
Mailing Address - Country:US
Mailing Address - Phone:937-462-8331
Mailing Address - Fax:937-462-8441
Practice Address - Street 1:127 S CHILLICOTHE ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:OH
Practice Address - Zip Code:45368-9786
Practice Address - Country:US
Practice Address - Phone:937-462-8331
Practice Address - Fax:937-462-8441
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-14481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2330098Medicaid