Provider Demographics
NPI:1770877854
Name:BOYER, RUTH ELLEN (RPH)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ELLEN
Last Name:BOYER
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 1:6601 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-4591
Mailing Address - Country:US
Mailing Address - Phone:847-244-4299
Mailing Address - Fax:847-244-4299
Practice Address - Street 1:6601 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-4591
Practice Address - Country:US
Practice Address - Phone:847-244-4299
Practice Address - Fax:847-244-4299
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-041017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051-041017OtherSTATE LICENSE