Healthcare Provider Details

I. General information

NPI: 1063961225
Provider Name (Legal Business Name): BRIAN STANLEY BOGDANOWICZ PHARMD, BCACP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 02/05/2023
Certification Date: 02/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15990 N GREENWAY HAYDEN LOOP STE D100
SCOTTSDALE AZ
85260-2269
US

IV. Provider business mailing address

4046 W ABRAHAM LN
GLENDALE AZ
85308-4772
US

V. Phone/Fax

Practice location:
  • Phone: 877-662-6633
  • Fax: 877-662-6355
Mailing address:
  • Phone: 815-412-4795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS022199
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: