MEDICARE: MICHEIL BOGGS CPHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	J3X7X9F6	OH

General Provider Information

NPI Number	:	1700277282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHEIL BOGGS CPHT

Provider Business Mailing Address
First Line	:	2205 WALKER LAKE RD
Second Line	:
City	:	ONTARIO
State	:	OH
Zip	:	44903-6519
Country	:	US
Telephone Number	:	419-747-1450
Fax Number	:

Provider Business Practice Location Address
First Line	:	2205 WALKER LAKE RD
Second Line	:
City	:	ONTARIO
State	:	OH
Zip	:	44903-6519
Country	:	US
Telephone Number	:	419-747-1450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2015
Last Update Date	:	02/05/2015

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