Grayson Mackenzie Boala

Primary specialty

PharmacistTaxonomy code 183500000X

License

PS63028 Issued in FL

Practice address

5999 Normandy Blvd
Jacksonville, FL 32205-6265

Phone

(904) 751-4346

NPI assigned

Sep 15, 2022

Last updated

Sep 15, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Holiday CVS L.L.C.

  dba Cvs Pharmacy #17915

  • Pharmacy
  • Wesley Chapel, FL
  • NPI 1770467466
  NPD (past)

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

{
    "created_epoch": "1663200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663200000000",
    "number": "1952023954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5999 NORMANDY BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322056265",
            "telephone_number": "904-751-4346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5999 NORMANDY BLVD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322056265",
            "telephone_number": "904-751-4346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOALA",
        "first_name": "GRAYSON",
        "middle_name": "MACKENZIE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-15",
        "last_updated": "2022-09-15",
        "certification_date": "2022-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS63028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee Marie Bluml, MS, RD
• Danielle Blunt
• Kayla Bluteau
• Kimberly Nguyen Blythe, APRN
• Bo WLMC LLC
• Adelina Georgina Boata
• Bernard Nana Adjei Boateng, MBA, DO, MS
• Martha Boateng
• Danielle Boatright Smiddy
• Cristal Boatright, PA-C

• Pharmacist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pharmacist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.