Provider Demographics
NPI:1043563117
Name:BOLTE, MARY E (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:BOLTE
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 1:75 LION DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-3849
Mailing Address - Country:US
Mailing Address - Phone:717-515-0623
Mailing Address - Fax:
Practice Address - Street 1:2101 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4808
Practice Address - Country:US
Practice Address - Phone:717-843-0197
Practice Address - Fax:717-843-0865
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037825L183500000X
MD12553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12553OtherMARYLAND PHARMACY LICENSE
PARP037825LOtherPA PHARMACY LICENSE