Provider Demographics
NPI:1508102096
Name:BOSGRA, JENNIFER (PHARMD D)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:BOSGRA
Suffix:
Gender:F
Credentials:PHARMD D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6576 WHITE PINE DR
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-5055
Mailing Address - Country:US
Mailing Address - Phone:928-595-3013
Mailing Address - Fax:
Practice Address - Street 1:191 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-674-7042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ134261835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist