Samantha Maria Bolivar, PHARM.D., RPH.
Individual provider Active NPI Pharmacist · Dedham, MA
NPI 1073988697 · NPPES record last updated Dec 8, 2015
Key facts
- NPI
- 1073988697
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 236117 (MA)
- Practice address
- 22 Marlboro St
Dedham, MA 02026-1423 - Phone
- (508) 821-6393
- NPI assigned
- Dec 8, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 236117 | MA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 236117 | MA | Yes |
Addresses
Primary practice location
22 Marlboro St
Dedham, MA 02026-1423
Mailing address
22 Marlboro St
Dedham, MA 02026-1423
Phone (508) 821-6393
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 236117 | Other | MA | MA BOP REGISTRATION |
Other providers in Dedham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 8, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.