Provider Demographics
NPI:1568848216
Name:BOEHM, NOEL
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:BOEHM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2341 CHICHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER CHICHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19061-3737
Mailing Address - Country:US
Mailing Address - Phone:610-485-1130
Mailing Address - Fax:610-485-9223
Practice Address - Street 1:2341 CHICHESTER AVE
Practice Address - Street 2:
Practice Address - City:UPPER CHICHESTER
Practice Address - State:PA
Practice Address - Zip Code:19061-3737
Practice Address - Country:US
Practice Address - Phone:610-485-1130
Practice Address - Fax:610-485-9223
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001480465002Medicaid
PA096230001Medicare PIN