Healthcare Provider Details

I. General information

NPI: 1386568012
Provider Name (Legal Business Name): AVNEET BOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 OCEAN BEACH HWY
LONGVIEW WA
98632-4801
US

IV. Provider business mailing address

500 W COLUMBIA WAY UNIT 515
VANCOUVER WA
98660-3631
US

V. Phone/Fax

Practice location:
  • Phone: 360-355-3082
  • Fax:
Mailing address:
  • Phone: 318-436-1503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRM.PH.61601570
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: