Provider Demographics
NPI:1073886693
Name:BOLTE, STEPHEN E (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:E
Last Name:BOLTE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 FOXMOORE AVE
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1912
Mailing Address - Country:US
Mailing Address - Phone:804-270-0467
Mailing Address - Fax:
Practice Address - Street 1:3520 ELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2723
Practice Address - Country:US
Practice Address - Phone:804-342-8864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist