MEDICARE: JEFFERY PAUL BOLOTTE 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	11492	LA
2	183500000X	Pharmacist	25401	TX

General Provider Information

NPI Number	:	1649261421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY PAUL BOLOTTE RPH

Provider Business Mailing Address
First Line	:	105 BERMUDA CIR
Second Line	:
City	:	SCOTT
State	:	LA
Zip	:	70583-4941
Country	:	US
Telephone Number	:	337-233-8210
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 KINGWOOD DR
Second Line	:	SUITE 110
City	:	HUMBLE
State	:	TX
Zip	:	77339-3060
Country	:	US
Telephone Number	:	877-361-0303
Fax Number	:

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/08/2007

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Directions to “ JEFFERY PAUL BOLOTTE RPH” Practice Location

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