Provider Demographics
NPI:1821370701
Name:BOGNER, LAURA DAVIS (RPH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DAVIS
Last Name:BOGNER
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 1:710 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770
Mailing Address - Country:US
Mailing Address - Phone:231-348-5556
Mailing Address - Fax:231-348-0826
Practice Address - Street 1:710 SPRING ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2851
Practice Address - Country:US
Practice Address - Phone:231-348-5556
Practice Address - Fax:231-348-0826
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025051183500000X
AZS018057183500000X
NV17907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist