Provider Demographics
NPI:1194008854
Name:BOGGS, COLIN W (PHARMD)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:W
Last Name:BOGGS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1220
Mailing Address - Country:US
Mailing Address - Phone:530-899-0887
Mailing Address - Fax:530-899-1769
Practice Address - Street 1:860 EAST AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1220
Practice Address - Country:US
Practice Address - Phone:530-899-0887
Practice Address - Fax:530-899-1769
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist