Provider Demographics
NPI:1114039245
Name:BOYAJIAN, SAM H (RPH)
Entity type:Individual
Prefix:MR
First Name:SAM
Middle Name:H
Last Name:BOYAJIAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-1309
Mailing Address - Country:US
Mailing Address - Phone:913-856-8106
Mailing Address - Fax:913-856-8802
Practice Address - Street 1:131 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-1309
Practice Address - Country:US
Practice Address - Phone:913-856-8106
Practice Address - Fax:913-856-8802
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1199310001Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID #