Elise Bogard
Individual provider Active NPI Pharmacist · Elkridge, MD
NPI 1376952192 · NPPES record last updated Aug 6, 2014
Key facts
- NPI
- 1376952192
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 19582 (MD)
- Practice address
- 6480 Old Waterloo Rd
Elkridge, MD 21075 - Phone
- (410) 799-0291
- Fax
- (410) 799-2589
- NPI assigned
- Aug 6, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI03210400 | NJ | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19582 | MD | Yes |
| Pharmacist | 183500000X | 28RI03210400 | NJ |
Addresses
Primary practice location
6480 Old Waterloo Rd
Elkridge, MD 21075
Mailing address
6480 Old Waterloo Rd
Elkridge, MD 21075
Phone (410) 799-0291
Other providers in Elkridge, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.