Provider Demographics
NPI:1487903902
Name:BOLLWINKEL, BRETT C (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:C
Last Name:BOLLWINKEL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8105 W FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8486
Mailing Address - Country:US
Mailing Address - Phone:208-323-9297
Mailing Address - Fax:208-327-0622
Practice Address - Street 1:8105 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8486
Practice Address - Country:US
Practice Address - Phone:208-323-9297
Practice Address - Fax:208-327-0622
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist