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General NPI Number Information
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NPI Number | 1417246752
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Entity Type | Individual
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Provider Name | JILL E BOGARD RPH
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Gender | Female
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | 530 W MARKET ST
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City | TIFFIN
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State | OH
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Zip | 44883-2610
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Country | US
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Telephone | 419-443-0189
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Fax |
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Provider Business Mailing Address
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Address Line | 8432 TOWNSHIP HIGHWAY 104
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City | UPPER SANDUSKY
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State | OH
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Zip | 43351-9341
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Country | US
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Telephone | 419-294-5235
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Fax | 419-294-5231
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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 | 03114950
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License Number State | OH
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