Provider Demographics
NPI:1609190057
Name:BOLSHEM, ARIE (RPH)
Entity Type:Individual
Prefix:MR
First Name:ARIE
Middle Name:
Last Name:BOLSHEM
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 1:2272 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6645
Mailing Address - Country:US
Mailing Address - Phone:718-241-0601
Mailing Address - Fax:718-372-2744
Practice Address - Street 1:2272 E 72ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6645
Practice Address - Country:US
Practice Address - Phone:718-241-0601
Practice Address - Fax:718-372-2744
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist