Provider Demographics
NPI:1215524145
Name:BOSTON, DEMETRI ANTONIO (RPH)
Entity type:Individual
Prefix:DR
First Name:DEMETRI
Middle Name:ANTONIO
Last Name:BOSTON
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 1:357 WINDIGROVE DR APT 1026
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-7598
Mailing Address - Country:US
Mailing Address - Phone:757-510-4979
Mailing Address - Fax:
Practice Address - Street 1:1302 BARTERBROOK RD
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-5013
Practice Address - Country:US
Practice Address - Phone:540-886-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist