MEDICARE: STEVEN PAUL BOERNER 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	S018370	AZ

General Provider Information

NPI Number	:	1689949406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN PAUL BOERNER RPH

Provider Business Mailing Address
First Line	:	20427 N HAYDEN RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-3874
Country	:	US
Telephone Number	:	480-419-2273
Fax Number	:	480-419-2267

Provider Business Practice Location Address
First Line	:	20427 N HAYDEN RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-3874
Country	:	US
Telephone Number	:	480-419-2273
Fax Number	:	480-419-2267

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

Provider Enumeration Date	:	03/12/2012
Last Update Date	:	03/12/2012

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