Active NPI
Anne Vinhan Boulom, RPH
- Pharmacist
- Clovis, CA
National Provider Identifier
1740577832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 55362
- Practice address
- 695 W Herndon Ave
T-2018
Clovis, CA 93612-0104 - Phone
- (559) 321-0010
- Fax
- (559) 326-1351
- NPI assigned
- Jul 8, 2011
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 55362 | CA | Primary |
Addresses
Primary practice location
695 W Herndon Ave
T-2018
Clovis, CA 93612-0104
Mailing address
695 W Herndon Ave
T-2018
Clovis, CA 93612-0104
Phone (559) 321-0010
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 55362 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310083200000",
"number": "1740577832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "695 W HERNDON AVE",
"address_2": "T-2018",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936120104",
"telephone_number": "559-321-0010",
"fax_number": "559-326-1351"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "695 W HERNDON AVE",
"address_2": "T-2018",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936120104",
"telephone_number": "559-321-0010",
"fax_number": "559-326-1351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULOM",
"first_name": "ANNE",
"middle_name": "VINHAN",
"name_prefix": "Dr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-08",
"last_updated": "2011-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "55362",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clovis, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.