Provider Demographics
NPI:1417246752
Name:BOGARD, JILL E (RPH)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:E
Last Name:BOGARD
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 1:8432 TOWNSHIP HIGHWAY 104
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-9341
Mailing Address - Country:US
Mailing Address - Phone:419-294-5235
Mailing Address - Fax:419-294-5231
Practice Address - Street 1:530 W MARKET ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2610
Practice Address - Country:US
Practice Address - Phone:419-443-0189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03114950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist