MEDICARE: BOSWELL PHARMACY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	PP415379L	PA
2	3336L0003X	Long Term Care Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2084943	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003803610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSWELL PHARMACY SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 266
Second Line	:
City	:	JENNERSTOWN
State	:	PA
Zip	:	15547-0266
Country	:	US
Telephone Number	:	814-629-1397
Fax Number	:	814-629-7644

Provider Business Practice Location Address
First Line	:	131 SCHOOLHOUSE RD
Second Line	:
City	:	JENNERSTOWN
State	:	PA
Zip	:	15547
Country	:	US
Telephone Number	:	814-629-1397
Fax Number	:	814-629-7644

Authorized Official
Title or Position	:	OWNER
Name	:	JACQUELINE MARTELLA
Credential	:	RPH
Telephone Number	:	814-629-1397

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	04/30/2024

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Directions to “BOSWELL PHARMACY SERVICES LLC ” Practice Location

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