Provider Demographics
NPI:1952730848
Name:BOARDMAN, HARVEY (RPH)
Entity Type:Individual
Prefix:MR
First Name:HARVEY
Middle Name:
Last Name:BOARDMAN
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 1:26400 GEORGE ZEIGER DR APT 304
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7511
Mailing Address - Country:US
Mailing Address - Phone:216-245-6078
Mailing Address - Fax:
Practice Address - Street 1:26400 GEORGE ZEIGER DR APT 304
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7511
Practice Address - Country:US
Practice Address - Phone:216-245-6078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03107213183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03107213OtherOHIO STATE BOARD OF PHARMACY