Provider Demographics
NPI:1699760298
Name:BOLTONS PHARMACY INC
Entity type:Organization
Organization Name:BOLTONS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED PHAMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGNOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:315-782-5961
Mailing Address - Street 1:128 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1989
Mailing Address - Country:US
Mailing Address - Phone:315-782-5961
Mailing Address - Fax:315-782-4496
Practice Address - Street 1:128 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1989
Practice Address - Country:US
Practice Address - Phone:315-782-5961
Practice Address - Fax:315-782-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015555332B00000X, 333600000X, 3336C0003X, 3336C0003X, 3336S0011X
3336L0003X
NY034984-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3347754OtherNABP
NY01077238Medicaid
NY0745930001Medicare NSC
NY3347754OtherNABP