Provider Demographics
NPI:1952373896
Name:KOLBE, BRUCE A (RPH)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:KOLBE
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 1:10170 FLINT RIDGE RD SE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43056-9265
Mailing Address - Country:US
Mailing Address - Phone:740-323-3797
Mailing Address - Fax:740-323-3788
Practice Address - Street 1:553 HEBRON RD
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1402
Practice Address - Country:US
Practice Address - Phone:740-522-6168
Practice Address - Fax:740-522-6312
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-09607183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist