Healthcare Provider Details

I. General information

NPI: 1801893904
Provider Name (Legal Business Name): JOEL BOERTH PHARMD, BCPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 RANCHO DEL ORO DR MAILCODE: 116Y
OCEANSIDE CA
92056
US

IV. Provider business mailing address

1300 RANCHO DEL ORO DR MAILCODE: 116Y
OCEANSIDE CA
92056
US

V. Phone/Fax

Practice location:
  • Phone: 760-643-2092
  • Fax:
Mailing address:
  • Phone: 760-643-2092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number9618
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: