Provider Demographics
NPI:1194502831
Name:BOGUSLAWSKI, MAYA CLARE (PHARMD)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:CLARE
Last Name:BOGUSLAWSKI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 PRAIRIE HEIGHTS DR APT 201
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-2218
Mailing Address - Country:US
Mailing Address - Phone:952-649-7677
Mailing Address - Fax:
Practice Address - Street 1:1450 EASTSIDE RD
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-9800
Practice Address - Country:US
Practice Address - Phone:608-342-4849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24857183500000X
WI22637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist