Provider Demographics
NPI:1568753655
Name:BOERGER, DENNIS ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:ALAN
Last Name:BOERGER
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 1:1081 MT. VERNON BLVD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302
Mailing Address - Country:US
Mailing Address - Phone:740-389-2700
Mailing Address - Fax:740-389-1850
Practice Address - Street 1:1081 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-5643
Practice Address - Country:US
Practice Address - Phone:740-389-2700
Practice Address - Fax:740-389-1850
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03211351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist