Provider Demographics
NPI:1376829341
Name:BOEHME, JEREMY T (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:T
Last Name:BOEHME
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700A COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-2449
Mailing Address - Country:US
Mailing Address - Phone:715-236-2676
Mailing Address - Fax:715-236-3359
Practice Address - Street 1:2700A COLLEGE DR
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-2449
Practice Address - Country:US
Practice Address - Phone:715-236-2676
Practice Address - Fax:715-236-3359
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-22
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6533183500000X, 1835P2201X, 1835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy