Provider Demographics
NPI:1679500151
Name:BORGE, LADONNA (RPH)
Entity Type:Individual
Prefix:MS
First Name:LADONNA
Middle Name:
Last Name:BORGE
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 1:120 JILL DR
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1677
Mailing Address - Country:US
Mailing Address - Phone:859-986-3113
Mailing Address - Fax:859-986-3733
Practice Address - Street 1:120 JILL DR
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1677
Practice Address - Country:US
Practice Address - Phone:859-986-3113
Practice Address - Fax:859-986-3733
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010756183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist