Provider Demographics
NPI:1003229063
Name:BOSS, SONYA BREMER (RPH)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:BREMER
Last Name:BOSS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:EVETTE
Other - Last Name:BREMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:3239 RIVERWALK DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70820-4342
Mailing Address - Country:US
Mailing Address - Phone:225-281-1475
Mailing Address - Fax:225-578-7163
Practice Address - Street 1:3239 RIVERWALK DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70820-4342
Practice Address - Country:US
Practice Address - Phone:225-281-1475
Practice Address - Fax:225-578-7163
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-07
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist