Basic Information
| Provider Information | |||||||||
| NPI: | 1649926825 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOEHM-BUHITE | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 907 DELRAY DR | ||||||||
| Address2: | |||||||||
| City: | FOREST HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210502749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103707029 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6455 MACHINE STREET | ||||||||
| Address2: | |||||||||
| City: | ABERDEEN PROVING GROUND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102781939 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2022 | ||||||||
| LastUpdateDate: | 02/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 02/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 15872 | MD | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.