Provider Demographics
NPI:1265026876
Name:BOGGS, KENNETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:BOGGS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1117
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-1117
Mailing Address - Country:US
Mailing Address - Phone:606-233-2063
Mailing Address - Fax:
Practice Address - Street 1:588 HIGHWAY 899
Practice Address - Street 2:
Practice Address - City:HINDMAN
Practice Address - State:KY
Practice Address - Zip Code:41822-8955
Practice Address - Country:US
Practice Address - Phone:606-785-3784
Practice Address - Fax:606-785-4510
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist