Provider Demographics
NPI:1659925121
Name:BOGGS, NICHOLE RENEE (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:RENEE
Last Name:BOGGS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:RENEE
Other - Last Name:LUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:PONCA
Mailing Address - State:NE
Mailing Address - Zip Code:68770
Mailing Address - Country:US
Mailing Address - Phone:712-898-1687
Mailing Address - Fax:
Practice Address - Street 1:7045 O ST.
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510
Practice Address - Country:US
Practice Address - Phone:402-484-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16499183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist