MEDICARE: SCOTT BOLESTA

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RP045571L	PA

General Provider Information

NPI Number	:	1669981403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT BOLESTA

Provider Business Mailing Address
First Line	:	105 WAKEFIELD RD
Second Line	:
City	:	SHAVERTOWN
State	:	PA
Zip	:	18708-9312
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 WELLES ST STE 128
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4961
Country	:	US
Telephone Number	:	570-714-6643
Fax Number	:

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

Provider Enumeration Date	:	09/25/2017
Last Update Date	:	09/25/2017

Similar Medicare Providers

1891780664 — ALLEN DANIEL SABATINO CRNP
Practice Location Address:

190 WELLES ST STE 122
FORTY FORT, PA
18704-4961

Practice Phone: 570-718-4140
Practice Fax: 570-718-4141

1770734378 — DR. PUNEET BAJAJ MD
Practice Location Address:

190 WELLES ST STE 122
FORTY FORT, PA
18704-4961

Practice Phone: 570-718-4140
Practice Fax: 570-718-4141

1578870226 — CHRISTINE SNYDER M.S., CCC-SLP
Practice Location Address:

190 WELLES ST STE 128
FORTY FORT, PA
18704-4961

Practice Phone: 570-522-9430
Practice Fax:

1174171821 — MS. TESSA CARMELA EBERLE CCC-SLP
Practice Location Address:

190 WELLES ST STE 128
FORTY FORT, PA
18704-4961

Practice Phone: 570-714-6420
Practice Fax:

1285257980 — ALYSON EVANS FLOYD MS, CGC
Practice Location Address:

190 WELLES ST STE 128
FORTY FORT, PA
18704-4961

Practice Phone: 570-714-6420
Practice Fax: 570-714-6601

1477226827 — RAVI DESAI PHARMD
Practice Location Address:

190 WELLES ST STE 128
FORTY FORT, PA
18704-4961

Practice Phone: 570-714-6635
Practice Fax:

Directions to “ SCOTT BOLESTA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.