Provider Demographics
NPI:1346259629
Name:BOLTE, PATRICK KEVIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:KEVIN
Last Name:BOLTE
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 1:1646 305TH STREET
Mailing Address - Street 2:
Mailing Address - City:TAMA
Mailing Address - State:IA
Mailing Address - Zip Code:50112
Mailing Address - Country:US
Mailing Address - Phone:641-484-9451
Mailing Address - Fax:641-484-4875
Practice Address - Street 1:4000 W DIMOND BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-1475
Practice Address - Country:US
Practice Address - Phone:505-603-2884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist