Provider Demographics
NPI:1194226191
Name:BOGAUDO, ROBERT (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:BOGAUDO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W4920 HANBURY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:VULCAN
Mailing Address - State:MI
Mailing Address - Zip Code:49892-8991
Mailing Address - Country:US
Mailing Address - Phone:906-282-1048
Mailing Address - Fax:
Practice Address - Street 1:W4920 HANBURY LAKE RD
Practice Address - Street 2:
Practice Address - City:VULCAN
Practice Address - State:MI
Practice Address - Zip Code:49892-8991
Practice Address - Country:US
Practice Address - Phone:906-282-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-24
Last Update Date:2018-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist