Charles Gibson Boenig, PHARMD
Individual provider Active NPI Pharmacist · Pomfret, MD
NPI 1972794915 · NPPES record last updated Aug 6, 2007
Key facts
- NPI
- 1972794915
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 10409 (MD)
- Practice address
- 4415 Guinevere LN
Pomfret, MD 20675-3205 - Phone
- (301) 934-4947
- NPI assigned
- Aug 6, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10409 | MD | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 10409 | MD | Yes |
Addresses
Primary practice location
4415 Guinevere LN
Pomfret, MD 20675-3205
Mailing address
4415 Guinevere LN
Pomfret, MD 20675-3205
Phone (301) 934-4947
Other providers in Pomfret, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.