Provider Demographics
NPI:1093861015
Name:BOHLMAN, JOHN PHILIP (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PHILIP
Last Name:BOHLMAN
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 1:205 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BOSCOBEL
Mailing Address - State:WI
Mailing Address - Zip Code:53805-1844
Mailing Address - Country:US
Mailing Address - Phone:608-375-5077
Mailing Address - Fax:608-375-2383
Practice Address - Street 1:1028 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:BOSCOBEL
Practice Address - State:WI
Practice Address - Zip Code:53805-1532
Practice Address - Country:US
Practice Address - Phone:608-375-4466
Practice Address - Fax:608-375-2383
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8708-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist