Provider Demographics
NPI:1235289877
Name:BOYD, LARDNER CLARK III (RPH)
Entity Type:Individual
Prefix:MR
First Name:LARDNER
Middle Name:CLARK
Last Name:BOYD
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:08518-2007
Mailing Address - Country:US
Mailing Address - Phone:609-499-3417
Mailing Address - Fax:609-499-9628
Practice Address - Street 1:31 E 4TH ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:NJ
Practice Address - Zip Code:08518-2007
Practice Address - Country:US
Practice Address - Phone:609-499-3417
Practice Address - Fax:609-499-9628
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01468100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist