Healthcare Provider Details

I. General information

NPI: 1275207458
Provider Name (Legal Business Name): ANDREA TIJANA BUZAKOVIC PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 YORKTOWN DR
BISMARCK ND
58503-8526
US

IV. Provider business mailing address

3219 TARRY TOWN PL
BISMARCK ND
58501-7721
US

V. Phone/Fax

Practice location:
  • Phone: 701-425-0789
  • Fax:
Mailing address:
  • Phone: 701-527-5232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6324
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: