Provider Demographics
NPI:1275827099
Name:BOGAR, CHRISTINE ROBERTS
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ROBERTS
Last Name:BOGAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 FLETCHER DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2183
Mailing Address - Country:US
Mailing Address - Phone:540-349-9504
Mailing Address - Fax:
Practice Address - Street 1:530 FLETCHER DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2183
Practice Address - Country:US
Practice Address - Phone:540-349-9504
Practice Address - Fax:540-349-9513
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2012-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist