Healthcare Provider Details

I. General information

NPI: 1316983786
Provider Name (Legal Business Name): DANIEL THOMAS BOGGIE PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 WELLER WAY
SACRAMENTO CA
95818-3736
US

IV. Provider business mailing address

1239 WELLER WAY
SACRAMENTO CA
95818-3736
US

V. Phone/Fax

Practice location:
  • Phone: 916-397-0488
  • Fax:
Mailing address:
  • Phone: 916-397-0488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12937
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number12937
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: