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NPI Code Detail

MEDICARE: DR. KELLY M BOLESTA PHARM.D.

MEDICARE: DR. KELLY M BOLESTA PHARM.D.
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
11835P1200XPharmacotherapy PharmacistRP438081PA
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistRP438081PA

General Provider Information

NPI Number : 1083684799
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY M BOLESTA PHARM.D.
Provider Business Mailing Address
First Line : 1000 E MOUNTAIN BLVD # MC34-06
Second Line :
City : WILKES BARRE
State : PA
Zip : 18711-0001
Country : US
Telephone Number : 570-808-7706
Fax Number : 570-808-6433
Provider Business Practice Location Address
First Line : 1000 E MOUNTAIN BLVD # MC34-06
Second Line :
City : WILKES BARRE
State : PA
Zip : 18711-0001
Country : US
Telephone Number : 570-808-7706
Fax Number : 570-808-6433
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2006
Last Update Date : 01/10/2022

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Directions to “ DR. KELLY M BOLESTA PHARM.D.” Practice Location

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