Healthcare Provider Details

I. General information

NPI: 1831181288
Provider Name (Legal Business Name): DELBERT ARTHUR BOLLMANN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E LYONS ST
MARISSA IL
62257-1141
US

IV. Provider business mailing address

8024 JONATHAN LANE
SPARTA IL
62286
US

V. Phone/Fax

Practice location:
  • Phone: 618-295-2317
  • Fax: 618-295-3772
Mailing address:
  • Phone: 618-443-4572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: