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General NPI Number Information
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NPI Number | 1316249519
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Entity Type | Organization
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Legal Business Name | BOLING PHARMACY INC
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Dates
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Enumeration Date | 11/22/2010
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Last Update Date | 08/07/2012
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Provider Practice Location Address
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Address Line | 133-37 41ST RD
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City | FLUSHING
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State | NY
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Zip | 11355
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Country | US
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Telephone | 718-321-9876
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Fax | 718-513-2047
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Provider Business Mailing Address
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Address Line | 13337 41ST RD
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City | FLUSHING
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State | NY
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Zip | 11355-3659
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Country | US
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Telephone | 718-321-9876
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Fax | 718-513-2047
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRISTAN LIU
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Credential |
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Telephone | 718-321-9876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 030329
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License Number State | NY
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