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General NPI Number Information
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NPI Number | 1417623182
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Entity Type | Individual
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Provider Name | MR. JAY CHESTER BOLTON III
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Gender | Male
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Dates
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Enumeration Date | 08/21/2021
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Last Update Date | 08/21/2021
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Provider Practice Location Address
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Address Line | 340 E MEIGHAN BLVD
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City | GADSDEN
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State | AL
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Zip | 35903-1049
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Country | US
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Telephone | 256-547-8928
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Fax |
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Provider Business Mailing Address
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Address Line | 6400 COUNTY ROAD 33
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City | ASHVILLE
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State | AL
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Zip | 35953-4258
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Country | US
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Telephone | 256-404-0301
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 11354
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License Number State | AL
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