Provider Demographics
NPI:1518951359
Name:BOUVIER PHARMACY INC
Entity Type:Organization
Organization Name:BOUVIER PHARMACY INC
Other - Org Name:BOUVIER PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUVIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-485-0432
Mailing Address - Street 1:515 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2088
Mailing Address - Country:US
Mailing Address - Phone:508-485-0432
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
MADS900373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2039144OtherPK
NY02923619Medicaid
NH30705177Medicaid
MA0418536Medicaid
NH30705177Medicaid