Provider Demographics
NPI:1093311862
Name:BOLTON, VON J (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:VON
Middle Name:J
Last Name:BOLTON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 CLAFLIN RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2785
Mailing Address - Country:US
Mailing Address - Phone:785-539-2345
Mailing Address - Fax:785-539-3494
Practice Address - Street 1:2429 CLAFLIN RD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2785
Practice Address - Country:US
Practice Address - Phone:785-539-2345
Practice Address - Fax:785-539-3494
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist