Healthcare Provider Details

I. General information

NPI: 1568753655
Provider Name (Legal Business Name): DENNIS ALAN BOERGER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 MOUNT VERNON AVE
MARION OH
43302-5643
US

IV. Provider business mailing address

1081 MT. VERNON BLVD
MARION OH
43302
US

V. Phone/Fax

Practice location:
  • Phone: 740-389-2700
  • Fax: 740-389-1850
Mailing address:
  • Phone: 740-389-2700
  • Fax: 740-389-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03211351
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: