Healthcare Provider Details

I. General information

NPI: 1639086317
Provider Name (Legal Business Name): DANIEL BOLLMANN PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 SPRING ST
RED BUD IL
62278-1105
US

IV. Provider business mailing address

830 SHERIDAN LN
WATERLOO IL
62298-3365
US

V. Phone/Fax

Practice location:
  • Phone: 618-282-3831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.292616
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: