Provider Demographics
NPI:1275668196
Name:BOLGER, GEORGE (RPH)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:BOLGER
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 1:7023 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3509
Mailing Address - Country:US
Mailing Address - Phone:301-371-5244
Mailing Address - Fax:
Practice Address - Street 1:7628 OLD NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-2002
Practice Address - Country:US
Practice Address - Phone:301-432-5488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist