Provider Demographics
NPI:1376052662
Name:BOEDER, KARLI JEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KARLI
Middle Name:JEAN
Last Name:BOEDER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KARLI
Other - Middle Name:JEAN
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:402 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-4633
Mailing Address - Country:US
Mailing Address - Phone:406-482-1420
Mailing Address - Fax:406-482-5338
Practice Address - Street 1:402 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-4633
Practice Address - Country:US
Practice Address - Phone:406-482-1420
Practice Address - Fax:406-482-5338
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-47489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist