MEDICARE: BOLIS BATOU 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	46884	CA

General Provider Information

NPI Number	:	1164743266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOLIS BATOU RPH

Provider Business Mailing Address
First Line	:	2647 FOOTHILL BLVD
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-3511
Country	:	US
Telephone Number	:	818-248-1016
Fax Number	:	818-248-0023

Provider Business Practice Location Address
First Line	:	2647 FOOTHILL BLVD
Second Line	:
City	:	LA CRESCENTA
State	:	CA
Zip	:	91214-3511
Country	:	US
Telephone Number	:	818-248-1016
Fax Number	:	818-248-0023

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

Provider Enumeration Date	:	06/13/2010
Last Update Date	:	06/13/2010

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