Provider Demographics
NPI:1962004994
Name:BOGGS, HEATHER LYNNETTE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNNETTE
Last Name:BOGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 WOODYARDS CAVE RD
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-8237
Mailing Address - Country:US
Mailing Address - Phone:304-483-1284
Mailing Address - Fax:
Practice Address - Street 1:701 GRAND CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-2143
Practice Address - Country:US
Practice Address - Phone:304-422-3526
Practice Address - Fax:304-485-3501
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV6190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist