MEDICARE: JENNIFER LYNN BOEHLER RPH

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	5415	MT

General Provider Information

NPI Number	:	1659710010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN BOEHLER RPH

Provider Business Mailing Address
First Line	:	3030 OUTFITTER TRL
Second Line	:
City	:	LAUREL
State	:	MT
Zip	:	59044-8358
Country	:	US
Telephone Number	:	406-628-7011
Fax Number	:

Provider Business Practice Location Address
First Line	:	2402 GRAND AVE
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-2623
Country	:	US
Telephone Number	:	406-252-5632
Fax Number	:

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

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	06/19/2013

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