Individual
LARRY GLENN BOLYARD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12305 ASHTON MILL TER, GLEN ALLEN, VA 23059-5487
(804) 512-4590
Mailing address
12305 ASHTON MILL TER, GLEN ALLEN, VA 23059-5487
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
0202007571
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0089651
CVS
—
Enumeration date
11/30/2020
Last updated
11/30/2020
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