Provider Demographics
NPI:1104428523
Name:BOYD, NATHAN D (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:D
Last Name:BOYD
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9411 S DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-5614
Mailing Address - Country:US
Mailing Address - Phone:918-299-5764
Mailing Address - Fax:
Practice Address - Street 1:9411 S DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-5614
Practice Address - Country:US
Practice Address - Phone:918-299-5764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist