Healthcare Provider Details

I. General information

NPI: 1215933536
Provider Name (Legal Business Name): KIMBERLY ANN BOAZ PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 BACKBAY DR
COLUMBUS OH
43235-8935
US

IV. Provider business mailing address

2412 BACKBAY DR
COLUMBUS OH
43235-8935
US

V. Phone/Fax

Practice location:
  • Phone: 785-760-2267
  • Fax:
Mailing address:
  • Phone: 785-760-2267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-2-26214
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: