Provider Demographics
NPI:1972819613
Name:BOULAJERIS, MARIA KITSA (RPH)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:KITSA
Last Name:BOULAJERIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-2710
Mailing Address - Country:US
Mailing Address - Phone:215-886-0472
Mailing Address - Fax:215-886-9748
Practice Address - Street 1:1441 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-2710
Practice Address - Country:US
Practice Address - Phone:215-886-0472
Practice Address - Fax:215-886-9748
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP043521L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist