Provider Demographics
NPI:1376141846
Name:BOHL, DEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:BOHL
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 1:1410 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56283-1906
Mailing Address - Country:US
Mailing Address - Phone:507-644-6000
Mailing Address - Fax:
Practice Address - Street 1:1410 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283-1906
Practice Address - Country:US
Practice Address - Phone:507-644-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117105183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist