Provider Demographics
NPI:1326152679
Name:BOLTON, YVONNE JOSEPHINE (PHARM D)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:JOSEPHINE
Last Name:BOLTON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3917 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-6782
Mailing Address - Country:US
Mailing Address - Phone:843-650-3653
Mailing Address - Fax:843-828-0338
Practice Address - Street 1:VA MYRTLE BEACH PRIMARY CARE CLINIC
Practice Address - Street 2:3381 PHILLIS BOULEVARD
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577
Practice Address - Country:US
Practice Address - Phone:843-477-0177
Practice Address - Fax:843-828-0338
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC005966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist