Provider Demographics
NPI:1942678586
Name:BOLDEN, ELDORA (PHARM D)
Entity Type:Individual
Prefix:
First Name:ELDORA
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 1:319 SOMERSET RD
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-5213
Mailing Address - Country:US
Mailing Address - Phone:504-442-7100
Mailing Address - Fax:
Practice Address - Street 1:1002 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-8001
Practice Address - Country:US
Practice Address - Phone:985-384-1447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.021050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist