Organization
BOULEVARD PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM JOHNSON (OWNER MANAGER PRESIDENT)
(336) 623-8881
Entity
Organization
Contact information
Practice address
256 THE BLVD, EDEN, NC 27288-4706
(336) 623-8448
(336) 623-1934
Mailing address
PO BOX 2186, EDEN, NC 27289-2186
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
06995
NC
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0795732
—
NC
01
—
3430674
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
09/21/2006
Last updated
09/11/2025
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