Provider Demographics
NPI:1154900918
Name:BOL, DAVID ATER (PHARMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ATER
Last Name:BOL
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 1:250 BASIN ST SW
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1852
Mailing Address - Country:US
Mailing Address - Phone:509-754-3513
Mailing Address - Fax:509-754-2714
Practice Address - Street 1:250 BASIN ST SW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1852
Practice Address - Country:US
Practice Address - Phone:509-754-3513
Practice Address - Fax:509-754-2714
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61072771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist