MEDICARE: MR. JAMES PATRICK BOLAND RPH

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	15875	IA
2	183500000X	Pharmacist	40403	MO

General Provider Information

NPI Number	:	1548476427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES PATRICK BOLAND RPH

Provider Business Mailing Address
First Line	:	428 EDGEWOOD LN
Second Line	:
City	:	PLEASANT HILL
State	:	IA
Zip	:	50327-9203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	428 EDGEWOOD LN
Second Line	:
City	:	PLEASANT HILL
State	:	IA
Zip	:	50327-9203
Country	:	US
Telephone Number	:	515-263-0712
Fax Number	:

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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