MEDICARE: JOEL D BOLIVER RPH

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	183500000X	Pharmacist	042072	NY

General Provider Information

NPI Number	:	1043490105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL D BOLIVER RPH

Provider Business Mailing Address
First Line	:	118 COVINGTON DR
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14220-2850
Country	:	US
Telephone Number	:	716-867-7768
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 CLINTON AVE N
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-4526
Country	:	US
Telephone Number	:	585-544-8210
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	11/06/2007

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