Provider Demographics
NPI:1841771706
Name:BOSO, ALEXIS JAYNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:JAYNE
Last Name:BOSO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LITTLE HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-9762
Mailing Address - Country:US
Mailing Address - Phone:803-760-0296
Mailing Address - Fax:
Practice Address - Street 1:5119 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9155
Practice Address - Country:US
Practice Address - Phone:803-520-2859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist