Provider Demographics
NPI:1053669937
Name:BOLOS, MICHAEL R (PHARMD, CSP)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:BOLOS
Suffix:
Gender:M
Credentials:PHARMD, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 BRODHEAD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3030
Mailing Address - Country:US
Mailing Address - Phone:877-836-9925
Mailing Address - Fax:866-418-6337
Practice Address - Street 1:3950 BRODHEAD RD STE 100
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3030
Practice Address - Country:US
Practice Address - Phone:877-836-9925
Practice Address - Fax:866-418-6337
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist