Bolbol LLC

Primary specialty

PharmacyTaxonomy code 333600000X

License

793 Issued in CT

Legal business name

BOLBOL LLC

Doing business as

The Medicine Shoppe 1442

Practice address

79 East St
Vernon Rockville, CT 06066-3845

Phone

(860) 775-2507

Fax

(860) 870-8160

NPI assigned

Feb 18, 2017

Last updated

Feb 18, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Nagy A Wassef, RPH

Title

Member

Phone

(860) 449-3097

Specialties & licenses 1

Addresses

Other names 1

• THE MEDICINE SHOPPE 1442 Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

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

{
    "created_epoch": "1487376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487376000000",
    "number": "1740729102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 EAST ST",
            "city": "VERNON ROCKVILLE",
            "state": "CT",
            "postal_code": "060663845",
            "telephone_number": "860-775-2507",
            "fax_number": "860-870-8160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 EAST ST",
            "city": "VERNON ROCKVILLE",
            "state": "CT",
            "postal_code": "060663845",
            "telephone_number": "860-775-2507",
            "fax_number": "860-870-8160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOLBOL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-18",
        "last_updated": "2017-02-18",
        "status": "A",
        "authorized_official_last_name": "WASSEF",
        "authorized_official_first_name": "NAGY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "860-449-3097",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CT",
            "license": "793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE MEDICINE SHOPPE 1442",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alzahraa Salam Khalid Alhameedawi, PHARMD
• Imran Lashari Balouch, MD
• Beacon Pharmacy LLC (Rockville Pharmacy)
• Beacon Prescription,Inc
• Diane Marie Blackwood, LMSW LADC
• Deanna Carter
• Lorraine Conderino
• Connecticut CVS Pharmacy, L.L.C. (CVS Pharmacy #02109)
• Constantinos A Constantinou, MD
• Lisa Corcoran, LCSW

• Pharmacy in Vernon Rockville, CT
• Providers in Vernon Rockville, CT by specialty
• Pharmacy in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2017; 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.