Individual
MICHAEL BOLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4076 NEELY ROAD, FORT WAINWRIGHT, AK 99709
(907) 361-5109
Mailing address
3010 DAVIS RD APT B3, FAIRBANKS, AK 99709-5236
(907) 347-4612
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
03236558
OH
Other
Enumeration date
03/15/2018
Last updated
03/15/2018
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