Healthcare Provider Details

I. General information

NPI: 1932381027
Provider Name (Legal Business Name): DALIA N BOULOS R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 COLUMBUS AVE RITE AID PHARMACY
NEW YORK NY
10025-6461
US

IV. Provider business mailing address

32 HARTLANDER ST
EAST BRUNSWICK NJ
08816-2667
US

V. Phone/Fax

Practice location:
  • Phone: 212-316-0436
  • Fax:
Mailing address:
  • Phone: 732-390-1315
  • Fax: 732-257-0881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047993-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: