Healthcare Provider Details

I. General information

NPI: 1346656592
Provider Name (Legal Business Name): JULIE DANIELLE BOLINGER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 LAKE AVE PHARMACY DEPT 119F
FORT WAYNE IN
46805-5100
US

IV. Provider business mailing address

2121 LAKE AVE PHARMACY DEPT 119F
FORT WAYNE IN
46805-5100
US

V. Phone/Fax

Practice location:
  • Phone: 260-426-5431
  • Fax:
Mailing address:
  • Phone: 260-426-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number26024676A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: