Provider Demographics
NPI:1326693730
Name:BOGGS-MOCK, KIRSTEN LEIGH (RPH)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LEIGH
Last Name:BOGGS-MOCK
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 1:200 STILLWATER LANDING WAY APT 302
Mailing Address - Street 2:
Mailing Address - City:SNEADS FERRY
Mailing Address - State:NC
Mailing Address - Zip Code:28460-6919
Mailing Address - Country:US
Mailing Address - Phone:912-414-4547
Mailing Address - Fax:
Practice Address - Street 1:702 W CORBETT AVE
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-8452
Practice Address - Country:US
Practice Address - Phone:910-325-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-04
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist