Provider Demographics
NPI:1225360340
Name:BOEVIN, MARY ELIZABETH (PHARMD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:BOEVIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:FLESHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:342 NORTHERN LIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4127
Mailing Address - Country:US
Mailing Address - Phone:315-455-7925
Mailing Address - Fax:180-036-5407
Practice Address - Street 1:342 NORTHERN LIGHTS DR
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-4127
Practice Address - Country:US
Practice Address - Phone:315-455-7925
Practice Address - Fax:180-036-5407
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist