Provider Demographics
NPI:1841373925
Name:BOEHNING, STEVE DUANE (RPH)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:DUANE
Last Name:BOEHNING
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4223 58TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4215
Mailing Address - Country:US
Mailing Address - Phone:701-541-5702
Mailing Address - Fax:701-293-6022
Practice Address - Street 1:3175 25TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6171
Practice Address - Country:US
Practice Address - Phone:701-293-6022
Practice Address - Fax:701-293-6040
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4451183500000X
MN115942-6183500000X
SD4696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist