Provider Demographics
NPI:1518102144
Name:BOEKLEY, KENNETH A (RPH)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:A
Last Name:BOEKLEY
Suffix:
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 1:3200 VINE ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2213
Mailing Address - Country:US
Mailing Address - Phone:513-861-3100
Mailing Address - Fax:
Practice Address - Street 1:5053 JULIANNE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-2366
Practice Address - Country:US
Practice Address - Phone:513-247-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03311821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist