Provider Demographics
NPI:1447455886
Name:BOLIVAR, MARIA PATRICIA (RPH)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:PATRICIA
Last Name:BOLIVAR
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 1:1945 MILK ST
Mailing Address - Street 2:
Mailing Address - City:DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02715-1135
Mailing Address - Country:US
Mailing Address - Phone:508-669-6606
Mailing Address - Fax:
Practice Address - Street 1:15 STATE RD
Practice Address - Street 2:
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3317
Practice Address - Country:US
Practice Address - Phone:508-441-5016
Practice Address - Fax:508-441-5001
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist