Provider Demographics
NPI:1336922061
Name:BOLINSKE, KAITLIN (PHARMD)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:BOLINSKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COMMONS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-3966
Mailing Address - Country:US
Mailing Address - Phone:512-858-7935
Mailing Address - Fax:512-858-5411
Practice Address - Street 1:2100 BROOKS ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6649
Practice Address - Country:US
Practice Address - Phone:406-728-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-48485183500000X
TX71439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist