Healthcare Provider Details

I. General information

NPI: 1407522816
Provider Name (Legal Business Name): PHILLIP COZARIUC PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3608 S LAFOUNTAIN ST
KOKOMO IN
46902-3809
US

IV. Provider business mailing address

1433 W MAIN ST APT 3A
CARMEL IN
46032-1478
US

V. Phone/Fax

Practice location:
  • Phone: 765-455-2191
  • Fax:
Mailing address:
  • Phone: 847-502-4618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26029428A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: