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1649805854 NPI number — GIZELLE GEVA MEDINACELI BOULTER PHARMD

NPI Number: 1649805854
Health Care Provider/Practitioner: GIZELLE GEVA MEDINACELI BOULTER PHARMD

Information about “1649805854” NPI (GIZELLE GEVA MEDINACELI BOULTER PHARMD) exists in 1649805854 in HTML format HTML  |  1649805854 in plain Text format TXT  |  1649805854 in PDF (Portable Document Format) PDF  |  1649805854 in an XML format XML  formats.

NPI Number : 1649805854 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1649805854",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOULTER",
    "FirstName": "GIZELLE GEVA",
    "MiddleName": "MEDINACELI",
    "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": "111 COLCHESTER AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BURLINGTON",
    "MailingAddressStateName": "VT",
    "MailingAddressPostalCode": "05401-1473",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "802-847-2885",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "111 COLCHESTER AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BURLINGTON",
    "PracticeLocationAddressStateName": "VT",
    "PracticeLocationAddressPostalCode": "05401-1473",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "802-847-9665",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/08/2020",
    "LastUpdateDate": "07/17/2025",
    "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": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "PHCY-00870",
          "LicenseNumberStateCode": "NH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "RPH6550",
          "LicenseNumberStateCode": "ND",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "033.0134443",
          "LicenseNumberStateCode": "VT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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