| NPI | 1821139023 |
|---|---|
| Doing Business As | BOULEVARD PHARMACEUTICAL COMPOUNDING CENTER |
| Entity Type | Organization |
| Authorized Contact | KHALID BOUKHATEM Owner 617-599-2793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy, Compounding Pharmacy |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: MA 2943) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2019-09-18 |