Healthcare Provider Details

I. General information

NPI: 1346259629
Provider Name (Legal Business Name): PATRICK KEVIN BOLTE PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W DIMOND BLVD
ANCHORAGE AK
99502-1475
US

IV. Provider business mailing address

1646 305TH STREET
TAMA IA
50112
US

V. Phone/Fax

Practice location:
  • Phone: 505-603-2884
  • Fax:
Mailing address:
  • Phone: 641-484-9451
  • Fax: 641-484-4875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11476
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: