Provider Demographics
NPI:1013611557
Name:BOYACK, LAURA A (CPHT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:BOYACK
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SAINT JAMES PL
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1411
Mailing Address - Country:US
Mailing Address - Phone:716-861-4021
Mailing Address - Fax:
Practice Address - Street 1:1410 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1111
Practice Address - Country:US
Practice Address - Phone:716-885-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician