Provider Demographics
NPI:1316248958
Name:BOEHME, DOUGLAS GRANT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GRANT
Last Name:BOEHME
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10576 KENAI SPUR HWY
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7811
Mailing Address - Country:US
Mailing Address - Phone:907-283-6360
Mailing Address - Fax:907-283-6319
Practice Address - Street 1:10576 KENAI SPUR HWY
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7811
Practice Address - Country:US
Practice Address - Phone:907-283-6360
Practice Address - Fax:907-283-6319
Is Sole Proprietor?:No
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist