Provider Demographics
NPI:1326599440
Name:BOGLAYEVA, ANNA ALEKSANDROVNA (RPH)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ALEKSANDROVNA
Last Name:BOGLAYEVA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:BOGLAYEV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17275 NW CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3297
Mailing Address - Country:US
Mailing Address - Phone:503-207-7632
Mailing Address - Fax:503-207-7628
Practice Address - Street 1:17275 NW CORNELL RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-3297
Practice Address - Country:US
Practice Address - Phone:503-207-7632
Practice Address - Fax:503-207-7628
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-00156641835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist