Provider Demographics
NPI:1306067061
Name:BOLEN, CHRISTY LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:LYNN
Last Name:BOLEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:WOODSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43793-1175
Mailing Address - Country:US
Mailing Address - Phone:740-310-1988
Mailing Address - Fax:
Practice Address - Street 1:1086 FRANKLIN ST
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905
Practice Address - Country:US
Practice Address - Phone:814-534-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist