Provider Demographics
NPI:1346525698
Name:BOGGAN, JEFF (RPH)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:BOGGAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 OLD ANDERSON RD UNIT 130
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1026
Mailing Address - Country:US
Mailing Address - Phone:615-367-4034
Mailing Address - Fax:
Practice Address - Street 1:7601 HIGHWAY 70 S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-1853
Practice Address - Country:US
Practice Address - Phone:615-646-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC-8977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist