Active NPI
Maresa Boshoff, PHARMACIST
- Pharmacist
- Broken Arrow, OK
National Provider Identifier
1720874670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 20902
- Practice address
- 1853 S Aspen Ave
Broken Arrow, OK 74012-5104 - Phone
- (918) 251-9615
- NPI assigned
- Apr 17, 2025
- Last updated
- Apr 17, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 20902 | OK | Primary |
Addresses
Primary practice location
1853 S Aspen Ave
Broken Arrow, OK 74012-5104
Mailing address
5311 E 102ND St
Tulsa, OK 74137-6037
Phone (918) 520-2811
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20902 | OK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oklahoma CVS Pharmacy LLC | Past | Accepting new patients | |
| Oklahoma CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1744848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1744848000000",
"number": "1720874670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5311 E 102ND ST",
"city": "TULSA",
"state": "OK",
"postal_code": "741376037",
"telephone_number": "918-520-2811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1853 S ASPEN AVE",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740125104",
"telephone_number": "918-251-9615"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOSHOFF",
"first_name": "MARESA",
"credential": "PHARMACIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-04-17",
"last_updated": "2025-04-17",
"certification_date": "2025-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "20902",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broken Arrow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.