Healthcare Provider Details

I. General information

NPI: 1093923740
Provider Name (Legal Business Name): BOGGS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 HIGHWAY 805
JENKINS KY
41537-0747
US

IV. Provider business mailing address

PO BOX 747
JENKINS KY
41537-0747
US

V. Phone/Fax

Practice location:
  • Phone: 606-832-2121
  • Fax: 606-832-2118
Mailing address:
  • Phone: 606-832-2121
  • Fax: 606-832-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP02547
License Number StateKY

VIII. Authorized Official

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