Provider Demographics
NPI:1831181288
Name:BOLLMANN, DELBERT ARTHUR (RPH)
Entity type:Individual
Prefix:MR
First Name:DELBERT
Middle Name:ARTHUR
Last Name:BOLLMANN
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 1:8024 JONATHAN LANE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286
Mailing Address - Country:US
Mailing Address - Phone:618-443-4572
Mailing Address - Fax:
Practice Address - Street 1:700 E LYONS ST
Practice Address - Street 2:
Practice Address - City:MARISSA
Practice Address - State:IL
Practice Address - Zip Code:62257-1141
Practice Address - Country:US
Practice Address - Phone:618-295-2317
Practice Address - Fax:618-295-3772
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist