Provider Demographics
NPI:1245606516
Name:BOYLES, SUSAN (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:BOYLES
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 295
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:AL
Mailing Address - Zip Code:36579-0295
Mailing Address - Country:US
Mailing Address - Phone:251-422-8038
Mailing Address - Fax:
Practice Address - Street 1:701 MCMEANS AVE
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-3337
Practice Address - Country:US
Practice Address - Phone:251-937-5553
Practice Address - Fax:251-937-6308
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL11251OtherPHARMACY LICENSE