NPIMap

Organization Active NPI

Boltons Pharmacy Inc

  • Community/Retail Pharmacy
  • Watertown, NY
National Provider Identifier
1699760298
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
015555 Issued in NY
Legal business name
BOLTONS PHARMACY INC
Practice address
128 W Main St
Watertown, NY 13601-1989
Phone
(315) 782-5961
Fax
(315) 782-4496
NPI assigned
Sep 20, 2005
Last updated
Jul 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Authorized official

Name
Dr. Colleen Signor, RPH
Title
Registered Phamacist
Phone
(315) 782-5961

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 015555 NY
Pharmacy 333600000X 015555 NY
Community/Retail Pharmacy 3336C0003X 015555 NY Primary
Long Term Care Pharmacy 3336L0003X NU

Addresses

Primary practice location

128 W Main St
Watertown, NY 13601-1989

Mailing address

128 W Main St
Watertown, NY 13601-1989
Phone (315) 782-5961

Other identifiers 2

IdentifierTypeStateIssuer
3347754OtherNYNABP
01077238MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20100930029170 NY DME Supplier - PharmacyDME Supplier - Medical Supply Company With Orthotic-ProstheticDME Supplier - Medical Supply CompanyDME Supplier - Medical Supply Company With Registered Pharmacist 6709905888 Practice locations: Watertown, NY
O20120608000022 NY Part B Supplier - Mass Immunization (Roster Biller Only) 6709905888 Practice locations: Watertown, NY
O20230531000072 NY Part B Supplier - Pharmacy 6709905888 Practice locations: Watertown, NY

National Provider Directory

National Provider Directory
Tax ID family
Bolton's Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688947200000",
    "number": "1699760298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 W MAIN ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136011989",
            "telephone_number": "315-782-5961",
            "fax_number": "315-782-4496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 W MAIN ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136011989",
            "telephone_number": "315-782-5961",
            "fax_number": "315-782-4496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLTONS PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-20",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A",
        "authorized_official_last_name": "SIGNOR",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "REGISTERED PHAMACIST",
        "authorized_official_telephone_number": "315-782-5961",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "015555",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "015555",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "015555",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "3347754",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01077238",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; 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.