Provider Demographics
NPI:1386926053
Name:BOELKE, TIFFANY LYNN (PHARMD, BCACP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LYNN
Last Name:BOELKE
Suffix:
Gender:F
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2669 COLD SPRING RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-6211
Mailing Address - Country:US
Mailing Address - Phone:317-966-1866
Mailing Address - Fax:
Practice Address - Street 1:2669 COLD SPRING RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-6211
Practice Address - Country:US
Practice Address - Phone:317-966-1866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019849A1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care