MEDICARE: BOLTON 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	3336C0003X	Community/Retail Pharmacy	PCY00911	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0702882	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780781070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOLTON PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 9216
Second Line	:
City	:	BOLTON
State	:	CT
Zip	:	06043-9216
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	667 BOSTON TPKE
Second Line	:
City	:	BOLTON
State	:	CT
Zip	:	06043-7401
Country	:	US
Telephone Number	:	860-643-0165
Fax Number	:	860-649-3783

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KARL LINK
Credential	:
Telephone Number	:	860-643-0165

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	06/04/2010

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Directions to “BOLTON PHARMACY INC ” Practice Location

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