Provider Demographics
NPI:1073862140
Name:BOSIN, JOSEPH HENRY
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HENRY
Last Name:BOSIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3631
Mailing Address - Country:US
Mailing Address - Phone:715-362-3999
Mailing Address - Fax:
Practice Address - Street 1:2200 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3631
Practice Address - Country:US
Practice Address - Phone:715-362-3999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2013-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17194-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist