Mark Debolt

NPI #1659671154 in Canon City, Colorado

Provider Information

NPI Number: 1659671154
Entity Type: Individual
Name: Mark Debolt
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Pharmacist
Enumeration Date: Oct 30, 2010
Last Updated: Oct 30, 2010

Practice Location

Address: 1414 MAIN ST
City: Canon City
State: Colorado
ZIP Code: 81212-3906
Phone: (719) 275-7511

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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