Boulevard Pharmacy Inc
Organization Active NPI Community/Retail Pharmacy · Eden, NC
NPI 1104924133 · NPPES record last updated Sep 11, 2025
Key facts
- NPI
- 1104924133
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- BOULEVARD PHARMACY INC
- Practice address
- 256 The Blvd
Eden, NC 27288-4706 - Phone
- (336) 623-8448
- Fax
- (336) 623-1934
- NPI assigned
- Sep 21, 2006
- Organization subpart
- No
Authorized official
- Name
- William Johnson
- Title
- Owner Manager President
- Phone
- (336) 623-8881
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 06995 | NC | |
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
256 The Blvd
Eden, NC 27288-4706
Mailing address
PO Box 2186
Eden, NC 27289-2186
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3430674 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 0795732 | Medicaid | NC |
Other providers in Eden, NC
- Ashya Black
- Annie Delores Blackwell
- Body & Face LLC
- Alyssa Horton Boles
- Angela Renee Boone
- Jane Everhart Bowman
- Amy Renee Boyd
- William S Boyd
- Janet G Brame
- Sarah Hadden Bridges
All providers in Eden, NC · Community/Retail Pharmacy in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2025. 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.