Provider Demographics
NPI:1457372930
Name:BOYLE, MAURA ELIZABETH (RPH)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:ELIZABETH
Last Name:BOYLE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1894 WILDER ST
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-8221
Mailing Address - Country:US
Mailing Address - Phone:517-339-0979
Mailing Address - Fax:517-882-8834
Practice Address - Street 1:5016 S MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-6126
Practice Address - Country:US
Practice Address - Phone:517-882-6750
Practice Address - Fax:517-882-8834
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist