Provider Demographics
NPI:1154554848
Name:BOYD, JANE K (RPH, CDE)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:K
Last Name:BOYD
Suffix:
Gender:F
Credentials:RPH, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AVERILL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12018-2506
Mailing Address - Country:US
Mailing Address - Phone:518-674-8823
Mailing Address - Fax:
Practice Address - Street 1:63 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:AVERILL PARK
Practice Address - State:NY
Practice Address - Zip Code:12018-2506
Practice Address - Country:US
Practice Address - Phone:518-674-8823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist