Provider Demographics
NPI:1003803610
Name:BOSWELL PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:BOSWELL PHARMACY SERVICES LLC
Other - Org Name:BOSWELL PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-629-1397
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:JENNERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15547-0266
Mailing Address - Country:US
Mailing Address - Phone:814-629-1397
Mailing Address - Fax:814-629-7644
Practice Address - Street 1:131 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:JENNERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15547
Practice Address - Country:US
Practice Address - Phone:814-629-1397
Practice Address - Fax:814-629-7644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP415379L333600000X, 333600000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2084943OtherPK
PA1007406150004Medicaid
2084943OtherPK
PA6445840001Medicare NSC