Provider Demographics
NPI:1093923740
Name:BOGGS PHARMACY
Entity Type:Organization
Organization Name:BOGGS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-832-2121
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:JENKINS
Mailing Address - State:KY
Mailing Address - Zip Code:41537-0747
Mailing Address - Country:US
Mailing Address - Phone:606-832-2121
Mailing Address - Fax:606-832-2118
Practice Address - Street 1:9500 HIGHWAY 805
Practice Address - Street 2:
Practice Address - City:JENKINS
Practice Address - State:KY
Practice Address - Zip Code:41537-0747
Practice Address - Country:US
Practice Address - Phone:606-832-2121
Practice Address - Fax:606-832-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP025473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4554309700Medicaid