Provider Demographics
NPI:1073625364
Name:BOLTE, CONNIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:
Last Name:BOLTE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 GLADYS DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-8097
Mailing Address - Country:US
Mailing Address - Phone:402-362-7561
Mailing Address - Fax:
Practice Address - Street 1:2029 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-1025
Practice Address - Country:US
Practice Address - Phone:402-362-4429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist