MEDICARE: MR. THOMAS CHARLES BOUVIER R.PH.

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
1	183500000X	Pharmacist	16413	MA

General Provider Information

NPI Number	:	1104117415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS CHARLES BOUVIER R.PH.

Provider Business Mailing Address
First Line	:	515 LINCOLN ST
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-2088
Country	:	US
Telephone Number	:	508-485-0432
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 LINCOLN ST
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-2088
Country	:	US
Telephone Number	:	508-485-0432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2011
Last Update Date	:	04/21/2011

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