Individual
LEONARD BOLOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
595 E PARKS HWY # 300, WASILLA, AK 99654-8102
(907) 352-1160
Mailing address
595 E PARKS HWY # 300, WASILLA, AK 99654-8102
(907) 352-1160
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
1705
AK
Other
Enumeration date
11/11/2010
Last updated
11/11/2010
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