Healthcare Provider Details

I. General information

NPI: 1538017553
Provider Name (Legal Business Name): NICHOLAS BOLIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2791 AGOURA RD
THOUSAND OAKS CA
91361-3101
US

IV. Provider business mailing address

11143 LAUGHLIN LN
NORTH HOLLYWOOD CA
91606-3666
US

V. Phone/Fax

Practice location:
  • Phone: 805-495-4938
  • Fax:
Mailing address:
  • Phone: 818-815-8423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number86556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: