Provider Demographics
NPI:1083995260
Name:POGGI, AUDRA LEE (PHARM D)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:LEE
Last Name:POGGI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:LEE
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1850 ADAMS ST
Mailing Address - Street 2:T-0663
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4864
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1850 ADAMS ST
Practice Address - Street 2:T-0663
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4864
Practice Address - Country:US
Practice Address - Phone:507-625-9009
Practice Address - Fax:507-625-9009
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-15545183500000X
MN120794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist