Provider Demographics
NPI:1538659636
Name:BOELTER, BRUCE FREDERICK (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:FREDERICK
Last Name:BOELTER
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 1:225 CROSSROADS BOULEVARD
Mailing Address - Street 2:PMB 331
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923
Mailing Address - Country:US
Mailing Address - Phone:310-893-4899
Mailing Address - Fax:
Practice Address - Street 1:450 E ROMIE LN
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4029
Practice Address - Country:US
Practice Address - Phone:831-759-2637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9874-040183500000X
AZS007212183500000X
TX59699183500000X
FLPS55787183500000X
CA44096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist