Provider Demographics
NPI:1326693730
Name:BOGGS-MOCK, KIRSTEN LEIGH (RPH)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LEIGH
Last Name:BOGGS-MOCK
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 1:747 OSBORNE RD
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-4503
Mailing Address - Country:US
Mailing Address - Phone:912-414-4547
Mailing Address - Fax:
Practice Address - Street 1:135 TOWN CENTER LOOP
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-6871
Practice Address - Country:US
Practice Address - Phone:828-452-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-04
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist