Healthcare Provider Details

I. General information

NPI: 1649926825
Provider Name (Legal Business Name): LISA BOEHM-BUHITE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6455 MACHINE STREET
ABERDEEN PROVING GROUND MD
21050
US

IV. Provider business mailing address

6455 MACHINE ST
ABERDEEN PROVING GROUND MD
21005-5213
US

V. Phone/Fax

Practice location:
  • Phone: 410-278-1939
  • Fax:
Mailing address:
  • Phone: 410-278-1936
  • Fax: 410-278-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15872
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number15872
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: