Healthcare Provider Details

I. General information

NPI: 1881613289
Provider Name (Legal Business Name): JAMES D BOLES PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E WOODROW WILSON AVE
JACKSON MS
39216-5116
US

IV. Provider business mailing address

225 WESTFIELD RD
RIDGELAND MS
39157-9753
US

V. Phone/Fax

Practice location:
  • Phone: 601-364-1550
  • Fax: 601-364-1578
Mailing address:
  • Phone: 601-364-1550
  • Fax: 601-364-1578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberE5686
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: