Healthcare Provider Details

I. General information

NPI: 1518951359
Provider Name (Legal Business Name): BOUVIER PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 LINCOLN ST
MARLBOROUGH MA
01752-2088
US

IV. Provider business mailing address

515 LINCOLN ST
MARLBOROUGH MA
01752-2088
US

V. Phone/Fax

Practice location:
  • Phone: 508-485-0432
  • Fax: 508-485-8777
Mailing address:
  • Phone: 508-485-0432
  • Fax: 508-485-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberDS90037
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRIAN BOUVIER
Title or Position: PRESIDENT
Credential:
Phone: 508-485-0432