Healthcare Provider Details

I. General information

NPI: 1912501222
Provider Name (Legal Business Name): ANDREA W BOSWELL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MAIN ST W
RAINSVILLE AL
35986-5944
US

IV. Provider business mailing address

PO BOX 1370
RAINSVILLE AL
35986-1370
US

V. Phone/Fax

Practice location:
  • Phone: 256-638-2255
  • Fax:
Mailing address:
  • Phone: 256-638-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14388
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: