Michael Bolan

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

03236558 Issued in OH

Practice address

4076 Neely Road
Fort Wainwright, AK 99709

Phone

(907) 361-5109

NPI assigned

Mar 15, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521072000000",
    "number": "1609379726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3010 DAVIS RD APT B3",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997095236",
            "telephone_number": "907-347-4612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4076 NEELY ROAD",
            "city": "FORT WAINWRIGHT",
            "state": "AK",
            "postal_code": "99709",
            "telephone_number": "907-361-5109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLAN",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-15",
        "last_updated": "2018-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "OH",
            "license": "03236558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Todd Beauchamp, M.D.
• Michael Berns, PHARMD
• Cathy Margaret Binder, RN / CPNP
• Alexander Daniel Blake, PA-C
• Stedmond L Blake
• Lori L. Bond
• Elizabeth Borgmeyer, PHARM.D.
• Younes Daniel Bouiri, PHARMD
• Patrick J Brady
• James Douglas Brewster, L.P.C.

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Fort Wainwright, AK
• Providers in Fort Wainwright, AK by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.