Provider Demographics
NPI:1619251212
Name:BORGMAN, JOE (RPH)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:BORGMAN
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 1:1185 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7729
Mailing Address - Country:US
Mailing Address - Phone:616-392-7504
Mailing Address - Fax:616-392-8021
Practice Address - Street 1:1185 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7729
Practice Address - Country:US
Practice Address - Phone:616-392-7504
Practice Address - Fax:616-392-8021
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-01
Last Update Date:2011-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023393183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric