Provider Demographics
NPI:1356996656
Name:BOALCH, CATHERINE (RPH, PHARMD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BOALCH
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E BELLE ISLE RD APT 621
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2397
Mailing Address - Country:US
Mailing Address - Phone:318-312-0553
Mailing Address - Fax:
Practice Address - Street 1:3695 CASCADE RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2173
Practice Address - Country:US
Practice Address - Phone:404-505-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist