Healthcare Provider Details

I. General information

NPI: 1245511054
Provider Name (Legal Business Name): CYNTHIA ANNE KOZIC PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 N GREEN BAY RD
WAUKEGAN IL
60085-2235
US

IV. Provider business mailing address

709 N GREEN BAY RD
WAUKEGAN IL
60085-2235
US

V. Phone/Fax

Practice location:
  • Phone: 847-662-8091
  • Fax:
Mailing address:
  • Phone: 847-662-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051287901
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: