Provider Demographics
NPI:1730778887
Name:BOSCH, LAUREN (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BOSCH
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 W HECKATHORN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MANCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46962-2219
Mailing Address - Country:US
Mailing Address - Phone:419-996-9192
Mailing Address - Fax:
Practice Address - Street 1:1201 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2405
Practice Address - Country:US
Practice Address - Phone:419-784-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027834A183500000X
OH03438488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist