Provider Demographics
NPI:1518258813
Name:BOUVIER, PHILIPPE DONALD (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILIPPE
Middle Name:DONALD
Last Name:BOUVIER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 WALCOTT CIR
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3161
Mailing Address - Country:US
Mailing Address - Phone:508-485-7050
Mailing Address - Fax:508-485-8777
Practice Address - Street 1:515 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2088
Practice Address - Country:US
Practice Address - Phone:508-485-0432
Practice Address - Fax:508-485-8777
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-21
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH14914183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist