Provider Demographics
NPI:1801905807
Name:BOLTINGHOUSE, LEONARD PHILLIP (RPH)
Entity type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:PHILLIP
Last Name:BOLTINGHOUSE
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 1:1716 VIRGINIA LN
Mailing Address - Street 2:
Mailing Address - City:KULPMONT
Mailing Address - State:PA
Mailing Address - Zip Code:17834-1950
Mailing Address - Country:US
Mailing Address - Phone:570-373-1077
Mailing Address - Fax:
Practice Address - Street 1:200 STATE HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-9103
Practice Address - Country:US
Practice Address - Phone:570-271-4535
Practice Address - Fax:570-271-4537
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029401L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist