Provider Demographics
NPI:1013027358
Name:KOZIELSKI, BETHANY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:KOZIELSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 HAMPSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-1908
Mailing Address - Country:US
Mailing Address - Phone:989-895-8947
Mailing Address - Fax:
Practice Address - Street 1:1454 W CENTER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-2112
Practice Address - Country:US
Practice Address - Phone:989-895-4580
Practice Address - Fax:989-895-4581
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist