# BOLBOL LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** The Medicine Shoppe 1442
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902423882
- **Authorized official:** NAGY WASSEF (MEMBER)
- **Authorized official phone:** (860) 875-2507

## Contact information

- **Practice address:** 79 EAST ST, VERNON, CT 06066-3845
- **Practice address phone:** (860) 875-2507
- **Practice address fax:** (860) 870-8160
- **Mailing address:** 79 EAST ST, VERNON, CT 06066-3845
- **Mailing address phone:** (860) 875-2507
- **Mailing address fax:** (860) 870-8160

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 06/26/2020
- **Last updated:** 06/26/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 008071088 | — | CT |