Healthcare Provider Details

I. General information

NPI: 1467599167
Provider Name (Legal Business Name): JODY L. BOLINSKE R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23831 RANCH VIEW CT
RAPID CITY SD
57702-7367
US

IV. Provider business mailing address

23831 RANCH VIEW CT
RAPID CITY SD
57702-7367
US

V. Phone/Fax

Practice location:
  • Phone: 701-770-7441
  • Fax:
Mailing address:
  • Phone: 701-770-7441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4476
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4421
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: