Provider Demographics
NPI:1417623182
Name:BOLTON, JAY CHESTER III
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:CHESTER
Last Name:BOLTON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 COUNTY ROAD 33
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35953-4258
Mailing Address - Country:US
Mailing Address - Phone:256-404-0301
Mailing Address - Fax:
Practice Address - Street 1:340 E MEIGHAN BLVD
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1049
Practice Address - Country:US
Practice Address - Phone:256-547-8928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-21
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist