Provider Demographics
NPI:1376852145
Name:BOGGS, PATRICK L
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:L
Last Name:BOGGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:PLAIN DEALING
Mailing Address - State:LA
Mailing Address - Zip Code:71064
Mailing Address - Country:US
Mailing Address - Phone:318-326-4229
Mailing Address - Fax:318-326-5903
Practice Address - Street 1:302 EAST PALMETTO STREET
Practice Address - Street 2:
Practice Address - City:PLAIN DEALING
Practice Address - State:LA
Practice Address - Zip Code:71064-0188
Practice Address - Country:US
Practice Address - Phone:318-326-4229
Practice Address - Fax:318-326-5903
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist