Healthcare Provider Details

I. General information

NPI: 1639707797
Provider Name (Legal Business Name): MARIE K BOZMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6804 S HESPERIDES ST
TAMPA FL
33616-2536
US

IV. Provider business mailing address

6804 S HESPERIDES ST
TAMPA FL
33616-2536
US

V. Phone/Fax

Practice location:
  • Phone: 678-910-8376
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License NumberPS59169
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: