Provider Demographics
NPI:1093033680
Name:BOISVERT, DONALD J (RPH)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:BOISVERT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 TROTTER LN
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-5334
Mailing Address - Country:US
Mailing Address - Phone:860-665-7717
Mailing Address - Fax:800-643-5093
Practice Address - Street 1:77 OLD BRICKYARD LN
Practice Address - Street 2:SUITE 1
Practice Address - City:BERLIN
Practice Address - State:CT
Practice Address - Zip Code:06037-1423
Practice Address - Country:US
Practice Address - Phone:800-282-4321
Practice Address - Fax:800-643-5093
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist