Provider Demographics
NPI:1720682057
Name:BOYDEN, JUSTIN D
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:D
Last Name:BOYDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BRISTOL PIKE
Mailing Address - Street 2:
Mailing Address - City:CROYDON
Mailing Address - State:PA
Mailing Address - Zip Code:19021-6267
Mailing Address - Country:US
Mailing Address - Phone:215-785-6345
Mailing Address - Fax:215-785-6971
Practice Address - Street 1:901 BRISTOL PIKE
Practice Address - Street 2:
Practice Address - City:CROYDON
Practice Address - State:PA
Practice Address - Zip Code:19021-6267
Practice Address - Country:US
Practice Address - Phone:215-785-6345
Practice Address - Fax:215-785-6971
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-441073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist