Healthcare Provider Details

I. General information

NPI: 1588570253
Provider Name (Legal Business Name): ROCKY BOSTIAN II PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CHURCH ST N
CONCORD NC
28025-2927
US

IV. Provider business mailing address

365 BOSTIAN OAKS LN
KANNAPOLIS NC
28081-7346
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-2132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835E0208X
TaxonomyEmergency Medicine Pharmacist
License Number26479
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: