Provider Demographics
NPI:1649547373
Name:BOSWELL, ALBERT ELLWSORTH III (RPH)
Entity type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:ELLWSORTH
Last Name:BOSWELL
Suffix:III
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 1:7714 CENTERBROOK CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-9223
Mailing Address - Country:US
Mailing Address - Phone:804-370-9060
Mailing Address - Fax:
Practice Address - Street 1:4201 MEADOWDALE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23234-5465
Practice Address - Country:US
Practice Address - Phone:804-271-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist