Active NPI
Marina Boulos
- Pharmacotherapy Pharmacist
- Bronx, NY
National Provider Identifier
1093666919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- 072781
- Practice address
- 111 E 210TH St
Bronx, NY 10467-2401 - Phone
- (908) 307-0088
- Fax
- (908) 307-0088
- NPI assigned
- Feb 6, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | 072781 | NY | Primary |
Addresses
Primary practice location
111 E 210TH St
Bronx, NY 10467-2401
Mailing address
32 Hartlander St
East Brunswick, NJ 08816-2667
Phone (908) 307-0088
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 072781 | NY | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1770336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1770336000000",
"number": "1093666919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32 HARTLANDER ST",
"city": "EAST BRUNSWICK",
"state": "NJ",
"postal_code": "088162667",
"telephone_number": "908-307-0088",
"fax_number": "908-307-0088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 E 210TH ST",
"city": "BRONX",
"state": "NY",
"postal_code": "104672401",
"telephone_number": "908-307-0088",
"fax_number": "908-307-0088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULOS",
"first_name": "MARINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-02-06",
"last_updated": "2026-02-06",
"certification_date": "2026-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "NY",
"license": "072781",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.