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General NPI Number Information
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NPI Number | 1831841121
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Entity Type | Individual
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Provider Name | VALENTIN BOGUN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 03/24/2022
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Provider Practice Location Address
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Address Line | 601 E DUPONT RD
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City | FORT WAYNE
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State | IN
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Zip | 46825-2055
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Country | US
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Telephone | 260-637-6115
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Fax |
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Provider Business Mailing Address
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Address Line | 429 W PIKE ST
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City | GOSHEN
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State | IN
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Zip | 46526-2362
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Country | US
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Telephone | 574-534-7616
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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 | CV2102887
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License Number State | IN
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