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General NPI Number Information
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NPI Number | 1093666919
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Entity Type | Individual
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Provider Name | MARINA BOULOS
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Gender | Female
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Dates
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Enumeration Date | 02/06/2026
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 111 E 210TH ST
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City | BRONX
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State | NY
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Zip | 10467-2401
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Country | US
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Telephone | 908-307-0088
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Fax | 908-307-0088
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Provider Business Mailing Address
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Address Line | 32 HARTLANDER ST
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-2667
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Country | US
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Telephone | 908-307-0088
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Fax | 908-307-0088
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 072781
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License Number State | NY
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