MEDICARE: MRS. TWILA DIANE BOYD R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03-3-14481	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144215658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TWILA DIANE BOYD R.PH.

Provider Business Mailing Address
First Line	:	PO BOX C
Second Line	:
City	:	SOUTH CHARLESTON
State	:	OH
Zip	:	45368-0803
Country	:	US
Telephone Number	:	937-462-8331
Fax Number	:	937-462-8441

Provider Business Practice Location Address
First Line	:	127 S CHILLICOTHE ST
Second Line	:
City	:	SOUTH CHARLESTON
State	:	OH
Zip	:	45368-9786
Country	:	US
Telephone Number	:	937-462-8331
Fax Number	:	937-462-8441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	05/24/2013

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