Healthcare Provider Details

I. General information

NPI: 1336922061
Provider Name (Legal Business Name): KAITLIN BOLINSKE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 BROOKS ST
MISSOULA MT
59801-6649
US

IV. Provider business mailing address

100 COMMONS RD STE 1
DRIPPING SPRINGS TX
78620-3966
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-2089
  • Fax:
Mailing address:
  • Phone: 512-858-7935
  • Fax: 512-858-5411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHA-PHA-LIC-48485
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71439
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: