Provider Demographics
NPI:1255564118
Name:BOLES, GAIL HOLGER (RPH)
Entity type:Individual
Prefix:MR
First Name:GAIL
Middle Name:HOLGER
Last Name:BOLES
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 1:3501 LOMAS BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1335
Mailing Address - Country:US
Mailing Address - Phone:505-255-8908
Mailing Address - Fax:
Practice Address - Street 1:3501 LOMAS NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1335
Practice Address - Country:US
Practice Address - Phone:505-255-8908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist