Provider Demographics
NPI:1831811371
Name:HOGG, CHRYSTOPHER MIKAEL BLAZE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHRYSTOPHER
Middle Name:MIKAEL BLAZE
Last Name:HOGG
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 1:7493 OAK RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49779-9506
Mailing Address - Country:US
Mailing Address - Phone:989-351-8608
Mailing Address - Fax:
Practice Address - Street 1:110 S BRADLEY HWY
Practice Address - Street 2:
Practice Address - City:ROGERS CITY
Practice Address - State:MI
Practice Address - Zip Code:49779-2123
Practice Address - Country:US
Practice Address - Phone:989-734-7392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist