Provider Demographics
NPI:1164596508
Name:BOYES PHARMACY
Entity Type:Organization
Organization Name:BOYES PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:BOYES
Authorized Official - Suffix:
Authorized Official - Credentials:R RH
Authorized Official - Phone:507-332-7451
Mailing Address - Street 1:301 CENTRAL AVE N
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5214
Mailing Address - Country:US
Mailing Address - Phone:507-332-7451
Mailing Address - Fax:507-332-0335
Practice Address - Street 1:301 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5214
Practice Address - Country:US
Practice Address - Phone:507-332-7451
Practice Address - Fax:507-332-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN260219-23336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2416762OtherNCPDP
MN0576630001Medicare ID - Type Unspecified