Active NPI
Brandon Boller
- Pharmacist
- Gig Harbor, WA
National Provider Identifier
1982032652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 60390061
- Practice address
- 4840 Borgen Blvd NW
Gig Harbor, WA 98332-6826 - Phone
- (253) 853-9340
- NPI assigned
- Oct 16, 2013
- Last updated
- Oct 16, 2013
- Sex
- Male
- 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 | 60390061 | WA | Primary |
Addresses
Primary practice location
4840 Borgen Blvd NW
Gig Harbor, WA 98332-6826
Mailing address
3214 N 7TH St
Tacoma, WA 98406-5906
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60390061 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1381881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1381881600000",
"number": "1982032652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3214 N 7TH ST",
"city": "TACOMA",
"state": "WA",
"postal_code": "984065906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4840 BORGEN BLVD NW",
"city": "GIG HARBOR",
"state": "WA",
"postal_code": "983326826",
"telephone_number": "253-853-9340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLLER",
"first_name": "BRANDON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-10-16",
"last_updated": "2013-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "60390061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gig Harbor, WA
- David Blunk, LMP
- Sara Boelman, MS, LMFT
- Annemarie Boeve
- Dillon Boland
- Amanda Boley, MA
- Shawna-Ray Boltin, LMT
- Bond Enterprises Inc (Olympic Pharmacy and Healthcare Services)
- Bond Enterprises Inc (Olympic Health Care Services)
- Bond Enterprises Inc
- Bond Enterprises Inc. (Olympic Pharmacy Health Care Services)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.