Healthcare Provider Details

I. General information

NPI: 1992309827
Provider Name (Legal Business Name): MICHAEL DAVID BOHN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2020
Last Update Date: 11/22/2020
Certification Date: 11/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 1ST ST STE 3A
BIRDSBORO PA
19508-2254
US

IV. Provider business mailing address

200 W 1ST ST STE 3A
BIRDSBORO PA
19508-2254
US

V. Phone/Fax

Practice location:
  • Phone: 610-582-4005
  • Fax: 610-404-4512
Mailing address:
  • Phone: 610-582-4005
  • Fax: 610-404-4512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP040721L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: