Provider Demographics
NPI:1689006355
Name:BOIRE, KENNETH GERALD (PHARMD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:GERALD
Last Name:BOIRE
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 1:1060 HEMMINGFORD RD
Mailing Address - Street 2:
Mailing Address - City:MOOERS
Mailing Address - State:NY
Mailing Address - Zip Code:12958-3632
Mailing Address - Country:US
Mailing Address - Phone:518-236-7127
Mailing Address - Fax:
Practice Address - Street 1:1060 HEMMINGFORD RD
Practice Address - Street 2:
Practice Address - City:MOOERS
Practice Address - State:NY
Practice Address - Zip Code:12958-3632
Practice Address - Country:US
Practice Address - Phone:518-236-7127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist