Provider Demographics
NPI:1548322696
Name:BOBROVICZ, BRIAN EDWARD (DPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EDWARD
Last Name:BOBROVICZ
Suffix:
Gender:M
Credentials:DPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 W ELK AVE RM 10
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1576
Mailing Address - Country:US
Mailing Address - Phone:580-255-7165
Mailing Address - Fax:
Practice Address - Street 1:2120 W ELK AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1500
Practice Address - Country:US
Practice Address - Phone:580-255-7165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist