Provider Demographics
NPI:1073840112
Name:BAZEWICZ, NICOLE LYNN (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LYNN
Last Name:BAZEWICZ
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:PITLIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:26731 US HIGHWAY 380 E
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-8210
Mailing Address - Country:US
Mailing Address - Phone:972-347-5112
Mailing Address - Fax:972-347-6120
Practice Address - Street 1:26731 US HIGHWAY 380 E
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-8210
Practice Address - Country:US
Practice Address - Phone:972-347-5112
Practice Address - Fax:972-347-6120
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45402183500000X
IN26022214A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist