Healthcare Provider Details

I. General information

NPI: 1407335524
Provider Name (Legal Business Name): DONALD JAMES BOLES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20622 N CAVE CREEK RD STE C-121 20622 N CAVE CREEK RD STE C-121
PHOENIX AZ
85024
US

IV. Provider business mailing address

20622 N CAVE CREEK RD STE C-121 20622 N CAVE CREEK RD STE C-121
PHOENIX AZ
85024
US

V. Phone/Fax

Practice location:
  • Phone: 480-351-8278
  • Fax: 480-351-8277
Mailing address:
  • Phone: 480-351-8278
  • Fax: 480-351-8277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberS022697
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: