Provider Demographics
NPI:1275128712
Name:BOLSTER, SCOTT (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:BOLSTER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MAIDSTONE LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-1663
Mailing Address - Country:US
Mailing Address - Phone:917-499-3021
Mailing Address - Fax:
Practice Address - Street 1:18 MAIDSTONE LN
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-1663
Practice Address - Country:US
Practice Address - Phone:917-499-3021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist