Healthcare Provider Details

I. General information

NPI: 1699856088
Provider Name (Legal Business Name): CAROLYN W. BOLAND RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7107 CHARLESTON HIGHWAY
BOWMAN SC
29018-0398
US

IV. Provider business mailing address

PO BOX 398
BOWMAN SC
29018-0398
US

V. Phone/Fax

Practice location:
  • Phone: 803-829-2547
  • Fax:
Mailing address:
  • Phone: 803-533-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5208
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: