Provider Demographics
NPI:1912283664
Name:BOSER, MONICA INGRID (PHARMD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:INGRID
Last Name:BOSER
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 1:11577 WATERVIEW CT
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-7773
Mailing Address - Country:US
Mailing Address - Phone:651-337-1124
Mailing Address - Fax:
Practice Address - Street 1:1965 DONEGAL DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4870
Practice Address - Country:US
Practice Address - Phone:651-735-0722
Practice Address - Fax:651-735-9248
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist