Provider Demographics
NPI:1245408632
Name:BOGDAN, HEATHER K (RPH)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:K
Last Name:BOGDAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 N STILES ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-5759
Mailing Address - Country:US
Mailing Address - Phone:908-486-4371
Mailing Address - Fax:
Practice Address - Street 1:651 N STILES ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-5759
Practice Address - Country:US
Practice Address - Phone:908-486-4371
Practice Address - Fax:908-486-8754
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02937600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist