Provider Demographics
NPI:1407424641
Name:BOGAR, KRISTIN (CPHT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BOGAR
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:KELTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10709 VAN NORHOP ST SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-8435
Mailing Address - Country:US
Mailing Address - Phone:360-515-1189
Mailing Address - Fax:
Practice Address - Street 1:909 E YELM AVE
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-9425
Practice Address - Country:US
Practice Address - Phone:360-515-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA60222370183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician