Provider Demographics
NPI:1649926825
Name:BOEHM-BUHITE, LISA (RPH)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:BOEHM-BUHITE
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 1:6455 MACHINE ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN PROVING GROUND
Mailing Address - State:MD
Mailing Address - Zip Code:21005-5213
Mailing Address - Country:US
Mailing Address - Phone:410-278-1936
Mailing Address - Fax:410-278-3520
Practice Address - Street 1:6455 MACHINE STREET
Practice Address - Street 2:
Practice Address - City:ABERDEEN PROVING GROUND
Practice Address - State:MD
Practice Address - Zip Code:21050
Practice Address - Country:US
Practice Address - Phone:410-278-1939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD158721835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care