# BOLAND PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649478025
- **Authorized official:** JULIAN BOLAND (OWNER)
- **Authorized official phone:** (803) 897-2133

## Contact information

- **Practice address:** 2732 CLEVELAND ST, ELLOREE, SC 29047
- **Practice address phone:** (803) 897-2133
- **Practice address fax:** (803) 897-2752
- **Mailing address:** PO BOX 50, ELLOREE, SC 29047-0050

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 50001693 | SC | Yes |

## Other

- **Enumeration date:** 07/06/2007
- **Last updated:** 09/23/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4212293 | OTHER ID NUMBER | — |
| 05 | — | 716933 | — | SC |