Provider Demographics
NPI:1609913383
Name:BOLINSKE, BRIAN P (RPH)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:BOLINSKE
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 1:23831 RANCH VIEW CT
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-7367
Mailing Address - Country:US
Mailing Address - Phone:701-770-6721
Mailing Address - Fax:
Practice Address - Street 1:23831 RANCH VIEW CT
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-7367
Practice Address - Country:US
Practice Address - Phone:701-770-6721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4424183500000X
NDRPH4475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4424OtherSTATE PHARMACY LICENSE
NDRPH4475OtherSTATE PHARMACY LICENSE