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NPI Code Detail

MEDICARE: MR. ALBERT ELLWSORTH BOSWELL III RPH

MEDICARE: MR. ALBERT ELLWSORTH BOSWELL III 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
1183500000XPharmacist0202009035VA

General Provider Information

NPI Number : 1649547373
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALBERT ELLWSORTH BOSWELL III RPH
Provider Business Mailing Address
First Line : 7714 CENTERBROOK CT
Second Line :
City : CHESTERFIELD
State : VA
Zip : 23832-9223
Country : US
Telephone Number : 804-370-9060
Fax Number :
Provider Business Practice Location Address
First Line : 4201 MEADOWDALE BLVD
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23234-5465
Country : US
Telephone Number : 804-271-8100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2011
Last Update Date : 11/23/2011

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