Provider Demographics
NPI:1932381027
Name:BOULOS, DALIA N (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DALIA
Middle Name:N
Last Name:BOULOS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HARTLANDER ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2667
Mailing Address - Country:US
Mailing Address - Phone:732-390-1315
Mailing Address - Fax:732-257-0881
Practice Address - Street 1:741 COLUMBUS AVE
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6461
Practice Address - Country:US
Practice Address - Phone:212-316-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047993-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist