Provider Demographics
NPI:1952519951
Name:BOINSKE, TERI A (RPH)
Entity type:Individual
Prefix:MS
First Name:TERI
Middle Name:A
Last Name:BOINSKE
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 1:19 BLEAR DR
Mailing Address - Street 2:
Mailing Address - City:EAST WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04030-5433
Mailing Address - Country:US
Mailing Address - Phone:207-608-3077
Mailing Address - Fax:
Practice Address - Street 1:1327 MAIN ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3657
Practice Address - Country:US
Practice Address - Phone:207-490-2069
Practice Address - Fax:207-490-2096
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR 5323183500000X
CTCT 9088183500000X
NHR1966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist