Organization
BOLBOL LLC
Active
Other names
The Medicine Shoppe 1442
Organization subpart
No
Provider details
NPI number
Authorized official
NAGY WASSEF (MEMBER)
(860) 875-2507
Entity
Organization
Contact information
Practice address
79 EAST ST, VERNON, CT 06066-3845
(860) 875-2507
(860) 870-8160
Mailing address
79 EAST ST, VERNON, CT 06066-3845
(860) 875-2507
(860) 870-8160
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008071088
—
CT
Enumeration date
06/26/2020
Last updated
06/26/2020
About Stedi
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