Individual
NICOLE MARIE BOUSTEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM.D
Contact information
Practice address
900 E BROADWAY AVE, BISMARCK, ND 58501-4520
(701) 530-6906
(701) 530-6907
Mailing address
789 SAN ANGELO DR, BISMARCK, ND 58504-7441
(701) 255-1673
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
4825
ND
Other
Enumeration date
07/03/2006
Last updated
07/08/2007
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