Provider Demographics
NPI:1689866519
Name:BOLTE, CECILY M (PHARMD)
Entity Type:Individual
Prefix:
First Name:CECILY
Middle Name:M
Last Name:BOLTE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 SAINT MICHAELS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7637
Mailing Address - Country:US
Mailing Address - Phone:505-995-2947
Mailing Address - Fax:505-995-2410
Practice Address - Street 1:440 SAINT MICHAELS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7637
Practice Address - Country:US
Practice Address - Phone:505-995-2947
Practice Address - Fax:505-995-2410
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006892183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist