Provider Demographics
NPI:1356618052
Name:BOEGE, KRISTINE MARIE (RPH)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:BOEGE
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 1:135 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-9322
Mailing Address - Country:US
Mailing Address - Phone:763-295-5890
Mailing Address - Fax:612-271-3376
Practice Address - Street 1:135 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-9322
Practice Address - Country:US
Practice Address - Phone:763-295-5890
Practice Address - Fax:612-271-3376
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist