Healthcare Provider Details

I. General information

NPI: 1457372930
Provider Name (Legal Business Name): MAURA ELIZABETH BOYLE RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 S MARTIN LUTHER KING JR BLVD
LANSING MI
48910-6126
US

IV. Provider business mailing address

1894 WILDER ST
HASLETT MI
48840-8221
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-6750
  • Fax: 517-882-8834
Mailing address:
  • Phone: 517-339-0979
  • Fax: 517-882-8834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302021835
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: