Healthcare Provider Details

I. General information

NPI: 1972819613
Provider Name (Legal Business Name): MARIA KITSA BOULAJERIS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 OLD YORK RD
ABINGTON PA
19001-2710
US

IV. Provider business mailing address

1441 OLD YORK RD
ABINGTON PA
19001-2710
US

V. Phone/Fax

Practice location:
  • Phone: 215-886-0472
  • Fax: 215-886-9748
Mailing address:
  • Phone: 215-886-0472
  • Fax: 215-886-9748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP043521L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: