Provider Demographics
NPI:1326385352
Name:BOES, QIANA TATUM (RPH)
Entity Type:Individual
Prefix:DR
First Name:QIANA
Middle Name:TATUM
Last Name:BOES
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 1:5630 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1102
Mailing Address - Country:US
Mailing Address - Phone:404-497-9324
Mailing Address - Fax:404-497-9329
Practice Address - Street 1:5630 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-1102
Practice Address - Country:US
Practice Address - Phone:404-497-9324
Practice Address - Fax:404-497-9329
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist