Healthcare Provider Details

I. General information

NPI: 1558716530
Provider Name (Legal Business Name): SUANNE BOEHM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15951 SW 41ST ST SUITE 200
DAVIE FL
33331-1535
US

IV. Provider business mailing address

15951 SW 41ST ST SUITE 200
DAVIE FL
33331-1535
US

V. Phone/Fax

Practice location:
  • Phone: 888-319-1818
  • Fax:
Mailing address:
  • Phone: 888-319-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS34256
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH24777
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: