Organization
BOLLING PRESCRIPTION LAB INC
Active
Other names
ROSELAND PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
HOWARD BOLLING (OWNER)
(773) 568-1050
Entity
Organization
Contact information
Practice address
11254 S MICHIGAN AVE, CHICAGO, IL 60628-4941
(773) 568-1050
(773) 568-1051
Mailing address
11254 S MICHIGAN AVE, CHICAGO, IL 60628-4941
(773) 568-1050
(773) 568-1051
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054005174
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1429693
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
6062801
—
IL
Enumeration date
07/30/2006
Last updated
10/08/2009
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