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General NPI Number Information
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NPI Number | 1962004994
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Entity Type | Individual
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Provider Name | HEATHER LYNNETTE BOGGS
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Gender | Female
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 701 GRAND CENTRAL AVE
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City | VIENNA
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State | WV
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Zip | 26105-2143
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Country | US
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Telephone | 304-422-3526
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Fax | 304-485-3501
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Provider Business Mailing Address
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Address Line | 340 WOODYARDS CAVE RD
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City | PARKERSBURG
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State | WV
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Zip | 26104-8237
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Country | US
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Telephone | 304-483-1284
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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 | 6190
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License Number State | WV
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