Provider Demographics
NPI:1699375295
Name:BOLDEN, MARQUITTA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARQUITTA
Middle Name:
Last Name:BOLDEN
Suffix:
Gender:F
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 1:152 ROLLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4716
Mailing Address - Country:US
Mailing Address - Phone:601-955-2278
Mailing Address - Fax:
Practice Address - Street 1:815 S WHEATLEY ST
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5002
Practice Address - Country:US
Practice Address - Phone:601-956-1466
Practice Address - Fax:601-957-1603
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist