Provider Demographics
NPI:1972810612
Name:BOYLES, KATHLEEN LATONA (RPH)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LATONA
Last Name:BOYLES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24288 THREE NOTCH ROAD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636
Mailing Address - Country:US
Mailing Address - Phone:301-373-3340
Mailing Address - Fax:
Practice Address - Street 1:24288 THREE NOTCH ROAD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636
Practice Address - Country:US
Practice Address - Phone:301-373-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist