Healthcare Provider Details

I. General information

NPI: 1376829341
Provider Name (Legal Business Name): JEREMY T BOEHME PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2011
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FEDERAL DR
FORT SNELLING MN
55111-4080
US

IV. Provider business mailing address

2700A COLLEGE DR
RICE LAKE WI
54868-2449
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-7901
  • Fax:
Mailing address:
  • Phone: 715-236-2676
  • Fax: 715-236-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP6533
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberP6533
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberP6533
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberP6533
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: