=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962797571
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS CARL BOGE PH.D., R.PH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2011
-----------------------------------------------------
Last Update Date | 06/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8101 W 151ST ST T1842
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66223-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-905-0420
-----------------------------------------------------
Fax | 913-905-0420
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8101 W 151ST ST T1842
-----------------------------------------------------
City | OVERLAND PARK
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66223-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-905-0420
-----------------------------------------------------
Fax | 913-905-0420
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 1-14101
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------