Healthcare Provider Details

I. General information

NPI: 1679888143
Provider Name (Legal Business Name): TAMARAH LYNN BOYSEL PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BIA ROUTE 125
PINEHILL NM
87357-0310
US

IV. Provider business mailing address

PO BOX 310
PINEHILL NM
87357-0310
US

V. Phone/Fax

Practice location:
  • Phone: 505-775-3933
  • Fax:
Mailing address:
  • Phone: 505-775-3933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02704100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: