Healthcare Provider Details

I. General information

NPI: 1922423169
Provider Name (Legal Business Name): FRANK HOZESKA PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12505 BARBARY CT
NEW BERLIN WI
53151-8285
US

IV. Provider business mailing address

12505 BARBARY CT
NEW BERLIN WI
53151-8285
US

V. Phone/Fax

Practice location:
  • Phone: 414-425-7577
  • Fax:
Mailing address:
  • Phone: 414-425-7577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10704-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: