MICHAEL BOLAN (NPI# 1609379726) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609379726 |
| Entity Type | Individual |
| Full Name | MICHAEL BOLAN |
| Practice Address |
4076 Neely Road Fort Wainwright AK 99709 |
| Mailing Address |
3010 Davis Rd Apt B3 Fairbanks AK 99709-5236 |
| Practice Telephone | 9073615109 |
| Mailing Telephone | 9073474612 |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2018-03-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1835P0018X |
Pharmacist Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
03236558 | OH | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659488807 | Michael Shawn Bolan | Family Medicine | 2272 32nd St Se, Kentwood, MI 49508-1509 | 2006-08-24 |
| 1457625246 | Michael Bolan | Social Worker | 21751 Ecorse Rd, Taylor, MI 48180-1846 | 2012-02-27 |
| Street Address |
4076 NEELY ROAD |
| City | FORT WAINWRIGHT |
| State | AK |
| Zip Code | 99709 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184611519 | Susan J Tate | Emergency Medicine | 4076 Neely Road, Fort Wainwright, AK 99703 | 2005-09-30 |
| 1588179535 | John David Boswell | Physician Assistant | 4076 Neely Road, Fort Wainwright, AK 99703 | 2017-12-12 |
| 1235677717 | Ashley Lynn Bain | Registered Nurse | 4076 Neely Road, Fort Wainwright, AK 99703 | 2017-02-06 |
| 1306380928 | John Merrill Manning | Psychologist | 4076 Neely Road, Attn: Dept of Behavioral Health, Fort Wainwright, AK 99703 | 2016-12-16 |
| 1891143129 | Brian Trinh | Pharmacist | 4076 Neely Road, Fort Wainwright, AK 99703 | 2016-05-26 |
| 1871951905 | Donia Inez Blauvelt | Pediatrics | 4076 Neely Road, Fort Wainwright, AK 99703-7400 | 2016-02-03 |
| 1952790974 | Meagen Sassman | Dietitian, Registered | 4076 Neely Road, Fort Wainwright, AK 99703-7440 | 2015-01-14 |
| 1568870418 | Ryan Michael Laplace | General Practice | 4076 Neely Road, Fort Wainwright, AK 99703 | 2014-07-23 |
| 1912317728 | Debora Renee Wells-mcmanus | Social Worker | 4076 Neely Road, Fort Wainwright, AK 99703 | 2014-05-01 |
| 1770877417 | Christina Marie Hylden | Orthopaedic Surgery | 4076 Neely Road, Fort Wainwright, AK 99703-7440 | 2011-05-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255946810 | Beacon Monitoring Professional Services | Technician, Other | 745 Staffordshire Rd, Fairbanks, AK 99709 | 2020-09-10 |
| 1235629544 | Fairbanks Healing Space | Health Educator | 3875 Geist Road, Suite E #136, Fairbanks, AK 99709 | 2018-05-11 |
| 1609395409 | Shawn K Goggins | Counselor | 1423 Peger Road, Fairbanks, AK 99709 | 2017-09-12 |
| 1710433347 | Jay Titus | Technician/Technologist | 2884 Marina Drive, Fairbanks, AK 99709 | 2016-09-01 |
| 1710391610 | Hannah Summerfelt | Dentist | 3539 Thomas St, Fairbanks, AK 99709 | 2014-06-18 |
| 1629407325 | Diane Louise Mitchell | Nurse Practitioner | 4650 Harvard Cir, Fairbanks, AK 99709 | 2013-11-04 |
| 1407147929 | Christina Martz | Counselor | 1270 Summet Drive, Fairbanks, AK 99709 | 2011-05-02 |
| 1255652285 | Surgery Center of Fairbanks LLC | Clinic/Center | 2310 Peger Road, Fairbanks, AK 99709 | 2010-06-14 |
| 1962661835 | John Leo Hughes Jr Jr. | Dentist | 3437 Airport Way, Suite 205, Fairbanks, AL 99709 | 2008-06-05 |
| 1508042417 | Katherine E Johnson, Md PC | Ophthalmology | 2485 Chief William Drive, Suite 100, Fairbanks, AK 99709 | 2008-01-10 |
| Find all providers in zip 99709 | ||||
| Taxonomy Code | 1835P0018X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |
| Notes: Source: National Uniform Claim Committee, 2007 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114263167 | Brian D Schilling | Pharmacist | Pcc Pharmacy, 4320 Diplomacy Dr, Anchorage, AK 99508-5925 | 2012-12-19 |
| 1093366601 | Heather Heidorn | Pharmacist | 528 Chief Eddie Hoffman Hwy, Bethel, AK 99559-0528 | 2019-09-25 |
| 1861043564 | Ashley Lourilea Hunsucker | Pharmacist | 700 Chief Eddie Hoffman Highway, Bethel, AK 99559 | 2019-09-24 |
| 1356990808 | Philip Quintero | Pharmacist | 1501 Huffman Rd, Anchorage, AK 99515-3596 | 2019-09-07 |
| 1780169094 | Michael Kristopher Frazier | Pharmacist | 1201 N Muldoon Rd, Anchorage, AK 99504-6104 | 2018-10-02 |
| 1932682127 | Devin Benjamin Drummond | Pharmacist | 1000 Greg Kruschek Ave, Nome, AK 99762 | 2018-09-13 |
| 1093244287 | Lauren Elizabeth Kaleta | Pharmacist | 106 Lincoln St, Sitka, AK 99835-7540 | 2017-06-09 |
| 1164956421 | Stephen John Sullivan Jr. | Pharmacist | 5955 Zeamer Ave # 673mdg, Jber, AK 99506-3702 | 2017-04-13 |
| 1346608445 | Allorie Timon Caldwell | Pharmacist | 3200 Providence Dr, Anchorage, AK 99508-4615 | 2016-02-03 |
| 1366851008 | Monika Maltese | Pharmacist | 1201 N Muldoon Rd, Anchorage, AK 99504-6104 | 2014-08-07 |
| Find all providers with the same taxonomy | ||||
| City | FORT WAINWRIGHT |
| Zip Code | 99709 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.