Boulevard Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

BOULEVARD PHARMACY INC

Practice address

1117 SE Frank Phillips Blvd
Bartlesville, OK 74003-4319

Phone

(918) 336-2140

Fax

(918) 336-2145

NPI assigned

Oct 26, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacey Cole

Title

Owner

Phone

(918) 336-2140

Specialties & licenses 5

Addresses

Other identifiers 2

Other names 1

• BOULEVARD PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gary Walter Bell Jr., R.PH.

  • Pharmacist
  • Bartlesville, OK
  • NPI 1114937018
  NPD (past)
• James Neil Maxwell, DPH

  • Pharmacist
  • Bartlesville, OK
  • NPI 1750464186
  NPD (past)
• Joshua Lennon Russell, PHARMD

  • Pharmacist
  • Bartlesville, OK
  • NPI 1376909101
  NPD (past)
• James Craig Sutterfield

  • Pharmacist
  • Bartlesville, OK
  • NPI 1215037759
  NPD (past)
• Julie Beth Williamson, RPH

  • Pharmacist
  • Bartlesville, OK
  • NPI 1467526012
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638921600000",
    "number": "1477638567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1117 SE FRANK PHILLIPS BLVD",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740034319",
            "telephone_number": "918-336-2140",
            "fax_number": "918-336-2145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1117 SE FRANK PHILLIPS BLVD",
            "city": "BARTLESVILLE",
            "state": "OK",
            "postal_code": "740034319",
            "telephone_number": "918-336-2140",
            "fax_number": "918-336-2145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "JACEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-336-2140"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3703801",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100232160A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BOULEVARD PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BOULEVARD PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jim Bolene, MD
• Lee Ann Bond
• Marilou G. Bork, LCSW
• Haley Chanel Borror, BS
• Amanda Nicole Boswell
• Boulevard Pharmacy Inc
• Nikki Lynn Bowers
• Bowles Pharmacy Inc
• Christopher Bowles
• Amber Bowman, APRN-CNS

• Community/Retail Pharmacy in Bartlesville, OK
• Providers in Bartlesville, OK by specialty
• Community/Retail Pharmacy in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.