Provider Demographics
NPI:1730710849
Name:BOEKE, BRENDA CHRISTENSEN (PHARMD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:CHRISTENSEN
Last Name:BOEKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10112 NE 98TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-9703
Mailing Address - Country:US
Mailing Address - Phone:816-820-3159
Mailing Address - Fax:
Practice Address - Street 1:5000 S 13TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5581
Practice Address - Country:US
Practice Address - Phone:913-290-7258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist