Provider Demographics
NPI:1982013256
Name:TOTAL HEALTH PHARMACISTS PLLC
Entity Type:Organization
Organization Name:TOTAL HEALTH PHARMACISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COFOUNDER/DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:315-836-3032
Mailing Address - Street 1:7744 SPIKE HORN PATH
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-4290
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7744 SPIKE HORN PATH
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-4290
Practice Address - Country:US
Practice Address - Phone:315-836-3032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty