Provider Demographics
NPI:1063774834
Name:BOLSTAD, HEATHER CAY (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:CAY
Last Name:BOLSTAD
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 5TH ST SW
Mailing Address - Street 2:
Mailing Address - City:ELYSIAN
Mailing Address - State:MN
Mailing Address - Zip Code:56028-9618
Mailing Address - Country:US
Mailing Address - Phone:507-327-9650
Mailing Address - Fax:
Practice Address - Street 1:1610 MONKS AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5173
Practice Address - Country:US
Practice Address - Phone:507-625-1553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-07
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist