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NPI Code Detail

MEDICARE: MARINA BOULOS

MEDICARE: MARINA BOULOS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P1200XPharmacotherapy Pharmacist072781NY

General Provider Information

NPI Number : 1093666919
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARINA BOULOS
Provider Business Mailing Address
First Line : 32 HARTLANDER ST
Second Line :
City : EAST BRUNSWICK
State : NJ
Zip : 08816-2667
Country : US
Telephone Number : 908-307-0088
Fax Number : 908-307-0088
Provider Business Practice Location Address
First Line : 111 E 210TH ST
Second Line :
City : BRONX
State : NY
Zip : 10467-2401
Country : US
Telephone Number : 908-307-0088
Fax Number : 908-307-0088
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2026
Last Update Date : 02/06/2026

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Directions to “ MARINA BOULOS ” Practice Location

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