Provider Demographics
NPI:1326596537
Name:BOLTJES, JEFF (RPH)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:BOLTJES
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 1:255 16TH ST SW
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-2959
Mailing Address - Country:US
Mailing Address - Phone:712-722-2326
Mailing Address - Fax:712-722-2589
Practice Address - Street 1:255 16TH ST SW
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-2959
Practice Address - Country:US
Practice Address - Phone:712-722-2326
Practice Address - Fax:712-722-2589
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18093183500000X
MN115616183500000X
SD4814183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist