Provider Demographics
NPI:1255749834
Name:BOLIN, CHRISTY (RPH)
Entity type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:
Last Name:BOLIN
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 1:4079 AUGUSTA HWY STE A
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:SC
Mailing Address - Zip Code:29054-8322
Mailing Address - Country:US
Mailing Address - Phone:803-892-5426
Mailing Address - Fax:
Practice Address - Street 1:4079 AUGUSTA HWY STE A
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:SC
Practice Address - Zip Code:29054-8322
Practice Address - Country:US
Practice Address - Phone:803-892-5426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4224793OtherPHARMACY NCPDP