Provider Demographics
NPI:1548435332
Name:BOZICEVICH, JOHN J
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:BOZICEVICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25355 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-4241
Mailing Address - Country:US
Mailing Address - Phone:248-399-4002
Mailing Address - Fax:248-399-4243
Practice Address - Street 1:25355 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-4241
Practice Address - Country:US
Practice Address - Phone:248-399-4002
Practice Address - Fax:248-399-4243
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist