Active NPI
Larry Glenn Bolyard Jr.
- Pharmacist
- Glen Allen, VA
National Provider Identifier
1265036214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 0202007571
- Practice address
- 12305 Ashton Mill Ter
Glen Allen, VA 23059-5487 - Phone
- (804) 512-4590
- NPI assigned
- Nov 30, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 0202007571 | VA | Primary |
Addresses
Primary practice location
12305 Ashton Mill Ter
Glen Allen, VA 23059-5487
Mailing address
12305 Ashton Mill Ter
Glen Allen, VA 23059-5487
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0089651 | Other | CVS |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Gbolyard@cvs.com | ||
| Direct Messaging Address | Gbolyard@cvs.com |
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 |
|---|---|---|---|
| 0202007571 | VA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606694400000",
"number": "1265036214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12305 ASHTON MILL TER",
"city": "GLEN ALLEN",
"state": "VA",
"postal_code": "230595487"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12305 ASHTON MILL TER",
"city": "GLEN ALLEN",
"state": "VA",
"postal_code": "230595487",
"telephone_number": "804-512-4590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLYARD",
"first_name": "LARRY",
"middle_name": "GLENN",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-30",
"last_updated": "2020-11-30",
"certification_date": "2020-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "VA",
"license": "0202007571",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CVS",
"identifier": "0089651",
"state": null
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "Gbolyard@cvs.com",
"affiliation": "N",
"address_1": "12305 Ashton Mill Ter",
"city": "Glen Allen",
"state": "VA",
"country_code": "US",
"postal_code": "230595487",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "Gbolyard@cvs.com",
"affiliation": "N",
"address_1": "12305 Ashton Mill Ter",
"city": "Glen Allen",
"state": "VA",
"country_code": "US",
"postal_code": "230595487",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Glen Allen, VA
- Bodyworks Physical Therapy and Rehabilitation
- Caroline Grace Bogan, PA-C
- Melanie Parham Boggs, MD
- Madison K Bollinger
- Chamir Bolton
- Bon Secours Ambulatory Services LLC
- Bon Secours Memorial Regional Medical Center LLC
- Bon Secours Urgent Care LLC
- Bon Secours Virginia Medical Group I, LLC
- Bon Secours-St. Mary'S Hospital of Richmond, Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.