Provider Demographics
NPI:1992309827
Name:BOHN, MICHAEL DAVID (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:BOHN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 1ST ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508-2254
Mailing Address - Country:US
Mailing Address - Phone:610-582-4005
Mailing Address - Fax:610-404-4512
Practice Address - Street 1:200 W 1ST ST STE 3A
Practice Address - Street 2:
Practice Address - City:BIRDSBORO
Practice Address - State:PA
Practice Address - Zip Code:19508-2254
Practice Address - Country:US
Practice Address - Phone:610-582-4005
Practice Address - Fax:610-404-4512
Is Sole Proprietor?:No
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040721L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist