Provider Demographics
NPI:1386113439
Name:BOULDER HOLDINGS, LLC
Entity type:Organization
Organization Name:BOULDER HOLDINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:GIVENS II
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-760-2287
Mailing Address - Street 1:1301 W HENDERSON ST STE L4-C
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-5100
Mailing Address - Country:US
Mailing Address - Phone:817-760-2287
Mailing Address - Fax:817-720-9987
Practice Address - Street 1:1301 W HENDERSON ST STE L4-C
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5100
Practice Address - Country:US
Practice Address - Phone:817-760-2287
Practice Address - Fax:817-720-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy