Provider Demographics
NPI:1538694948
Name:BOYLAN, PAUL MICHAEL (PHARMD, BCPS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:BOYLAN
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 N STONEWALL AVE # CPB239
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1200
Mailing Address - Country:US
Mailing Address - Phone:405-271-6878
Mailing Address - Fax:405-271-6430
Practice Address - Street 1:1110 N STONEWALL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1200
Practice Address - Country:US
Practice Address - Phone:405-271-6878
Practice Address - Fax:405-271-6430
Is Sole Proprietor?:No
Enumeration Date:2017-04-23
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449041183500000X
FLPS54925183500000X
OK18861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist