Provider Demographics
NPI:1205461993
Name:BOSNJAK, RUTH (PHD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:
Last Name:BOSNJAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 CLUB CIR APT 302N
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6993
Mailing Address - Country:US
Mailing Address - Phone:414-305-4156
Mailing Address - Fax:
Practice Address - Street 1:7520 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-3546
Practice Address - Country:US
Practice Address - Phone:414-771-9146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19039-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist