Healthcare Provider Details

I. General information

NPI: 1700616034
Provider Name (Legal Business Name): BOLERO PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 W HUBBARD ST STE 701
CHICAGO IL
60654-4909
US

IV. Provider business mailing address

351 W HUBBARD ST STE 701
CHICAGO IL
60654-4909
US

V. Phone/Fax

Practice location:
  • Phone: 877-220-8181
  • Fax:
Mailing address:
  • Phone: 877-220-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. JOEL SABAN
Title or Position: MANAGER
Credential:
Phone: 847-687-9321