Provider Demographics
NPI:1598040651
Name:BOHL, AMY LYNN (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:BOHL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-1328
Mailing Address - Country:US
Mailing Address - Phone:515-282-5295
Mailing Address - Fax:515-282-7057
Practice Address - Street 1:3140 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1328
Practice Address - Country:US
Practice Address - Phone:515-282-5295
Practice Address - Fax:515-282-7057
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist