Healthcare Provider Details

I. General information

NPI: 1124151634
Provider Name (Legal Business Name): IRINA M BOGUK PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 EAST AVE
PAWTUCKET RI
02860-6184
US

IV. Provider business mailing address

17 LORI DR
NORTH PROVIDENCE RI
02911-1102
US

V. Phone/Fax

Practice location:
  • Phone: 401-724-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number04458
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26340
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: