Organization
BOULEVARD PHARMACY INC
Active
Other names
BOULEVARD PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JACEY COLE (OWNER)
(918) 336-2140
Entity
Organization
Contact information
Practice address
1117 SE FRANK PHILLIPS BLVD, BARTLESVILLE, OK 74003-4319
(918) 336-2140
(918) 336-2145
Mailing address
1117 SE FRANK PHILLIPS BLVD, BARTLESVILLE, OK 74003-4319
(918) 336-2140
(918) 336-2145
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100232160A
—
OK
01
—
3703801
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
10/26/2006
Last updated
12/08/2021
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