Provider Demographics
NPI:1164905105
Name:BOZIKIS, TERESA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:
Last Name:BOZIKIS
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 1:3822 S KINGSHIGHWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-1817
Mailing Address - Country:US
Mailing Address - Phone:314-773-1384
Mailing Address - Fax:314-773-1971
Practice Address - Street 1:5378 SOUTHWEST AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-1446
Practice Address - Country:US
Practice Address - Phone:314-776-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1023024411Medicaid