Provider Demographics
NPI:1992080782
Name:BOLEJACK, PARKER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PARKER
Middle Name:
Last Name:BOLEJACK
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 1:550 S 129TH ST
Mailing Address - Street 2:
Mailing Address - City:BONNER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66012-9210
Mailing Address - Country:US
Mailing Address - Phone:913-543-5001
Mailing Address - Fax:913-543-5007
Practice Address - Street 1:3333 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208
Practice Address - Country:US
Practice Address - Phone:316-682-2999
Practice Address - Fax:316-682-4515
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist