Individual
JOHN BOLA EMMANUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMACIST
Contact information
Practice address
3606 GREENSTONE PL, VALRICO, FL 33596-6919
(813) 588-9275
Mailing address
3606 GREENSTONE PL, VALRICO, FL 33596-6919
(135) 889-2758
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
PS41842
FL
1835G0303X
Geriatric Pharmacist
Primary
PSA41842
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PS 41842
LICENSE
FL
Enumeration date
02/03/2012
Last updated
06/06/2024
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