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1215788955 NPI number — MELISSA DIANE BOULWARE PHARMD

NPI Number: 1215788955
Health Care Provider/Practitioner: MELISSA DIANE BOULWARE PHARMD

Information about “1215788955” NPI (MELISSA DIANE BOULWARE PHARMD) exists in 1215788955 in HTML format HTML  |  1215788955 in plain Text format TXT  |  1215788955 in PDF (Portable Document Format) PDF  |  1215788955 in an XML format XML  formats.

NPI Number : 1215788955 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215788955",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOULWARE",
    "FirstName": "MELISSA",
    "MiddleName": "DIANE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7800 OAKMONT BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT WORTH",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76132-4203",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7800 OAKMONT BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT WORTH",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76132-4203",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "817-346-0094",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/29/2024",
    "LastUpdateDate": "03/29/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1835G0303X",
          "TaxonomyName": "Geriatric Pharmacist",
          "LicenseNumber": "53402",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "53402",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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