Healthcare Provider Details

I. General information

NPI: 1790863710
Provider Name (Legal Business Name): BOGGS PHARMACY,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 HIGHWAY 805
JENKINS KY
41537
US

IV. Provider business mailing address

PO BOX 747
JENKINS KY
41537
US

V. Phone/Fax

Practice location:
  • Phone: 606-832-2121
  • Fax:
Mailing address:
  • Phone: 606-832-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberP02547
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberP02547
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3336C0003X
License Number StateKY

VIII. Authorized Official

Name: WENDELL D BOGGS
Title or Position: PRESIDENT PHARMACIST
Credential: RPH
Phone: 606-832-2121