Provider Demographics
NPI:1447691126
Name:BOGENREIF, EMILY ROSE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ROSE
Last Name:BOGENREIF
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 1:2935 40TH AVE S
Mailing Address - Street 2:UNIT D
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6692
Mailing Address - Country:US
Mailing Address - Phone:701-388-1257
Mailing Address - Fax:701-293-6040
Practice Address - Street 1:3175 25TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6171
Practice Address - Country:US
Practice Address - Phone:701-293-6022
Practice Address - Fax:701-293-6040
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist