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General NPI Number Information
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NPI Number | 1588152169
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Entity Type | Individual
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Provider Name | WILLIAM BOORSE PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 04/29/2018
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Last Update Date | 04/29/2018
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Provider Practice Location Address
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Address Line | 1727 W LIBERTY ST UNIT 2
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City | ALLENTOWN
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State | PA
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Zip | 18104
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Country | US
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Telephone | 610-351-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 6180 MUD RUN ROAD
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City | NAZARETH
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State | PA
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Zip | 18064
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Country | US
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Telephone | 610-554-5747
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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 | RP038885L
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License Number State | PA
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