Provider Demographics
NPI:1801893904
Name:BOERTH, JOEL (PHARMD, BCPP)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:BOERTH
Suffix:
Gender:M
Credentials:PHARMD, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 RANCHO DEL ORO DR
Mailing Address - Street 2:MAILCODE: 116Y
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056
Mailing Address - Country:US
Mailing Address - Phone:760-643-2092
Mailing Address - Fax:
Practice Address - Street 1:1300 RANCHO DEL ORO DR
Practice Address - Street 2:MAILCODE: 116Y
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056
Practice Address - Country:US
Practice Address - Phone:760-643-2092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT96181835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric