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General NPI Number Information
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NPI Number | 1194502831
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Entity Type | Individual
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Provider Name | MAYA CLARE BOGUSLAWSKI PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/14/2023
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 1450 EASTSIDE RD
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City | PLATTEVILLE
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State | WI
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Zip | 53818-9800
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Country | US
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Telephone | 608-342-4849
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Fax |
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Provider Business Mailing Address
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Address Line | 302 PRAIRIE HEIGHTS DR APT 201
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City | VERONA
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State | WI
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Zip | 53593-2218
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Country | US
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Telephone | 952-649-7677
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 24857
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 22637
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License Number State | WI
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