Basic Information
| Provider Information | |||||||||
| NPI: | 1346338910 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOESE | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.PH. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | RR 4 BOX 281A | ||||||||
| Address2: | |||||||||
| City: | WEATHERFORD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730969121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803432656 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | RR 1 BOX 3060 | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 736019303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803232884 | ||||||||
| FaxNumber: | 5803232579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1200X | 11324 | OK | Y | Pharmacy Service Providers | Pharmacist | Pharmacotherapy |
No ID Information.