Healthcare Provider Details

I. General information

NPI: 1295047264
Provider Name (Legal Business Name): KATHLEEN MARY LEHAULT PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. KATHLEEN MARY BOLAN

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WASHINGTON RD
WEST POINT NY
10996-1109
US

IV. Provider business mailing address

4 W LAKE RD
WARWICK NY
10990-2605
US

V. Phone/Fax

Practice location:
  • Phone: 845-938-4114
  • Fax: 845-938-1120
Mailing address:
  • Phone: 714-475-9458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number63238
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number63238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: