Provider Demographics
NPI:1962798678
Name:BOLSTER, KATIE ROSE (PHARMD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ROSE
Last Name:BOLSTER
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 1:3827 MARKETPLACE DR NW
Mailing Address - Street 2:TARGET PHARMACY T-1351
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3192
Mailing Address - Country:US
Mailing Address - Phone:507-536-3898
Mailing Address - Fax:507-536-3898
Practice Address - Street 1:3827 MARKETPLACE DR NW
Practice Address - Street 2:TARGET PHARMACY T-1351
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3192
Practice Address - Country:US
Practice Address - Phone:507-536-3898
Practice Address - Fax:507-536-3898
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist