MEDICARE: BOUVIER PHARMACY INC

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
2	3336L0003X	Long Term Care Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	3336C0003X	Community/Retail Pharmacy	DS90037	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2039144	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518951359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOUVIER PHARMACY INC

Provider Business Mailing Address
First Line	:	515 LINCOLN ST
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-2088
Country	:	US
Telephone Number	:	508-485-0432
Fax Number	:	508-485-8777

Provider Business Practice Location Address
First Line	:	515 LINCOLN ST
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-2088
Country	:	US
Telephone Number	:	508-485-0432
Fax Number	:	508-485-8777

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN BOUVIER
Credential	:
Telephone Number	:	508-485-0432

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	01/18/2017

Similar Medicare Providers

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Practice Location Address:

515 LINCOLN ST
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01752-2088

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1104117415 — MR. THOMAS CHARLES BOUVIER R.PH.
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1851868962 — ASHLEY MARIE GAUTHIER RPH
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1124450705 — AMBEREEN FATIMA DDS
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1154126175 — I-SMILE DENTAL ARTS STUDIO PC
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Directions to “BOUVIER PHARMACY INC ” Practice Location

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