Provider Demographics
NPI:1316542285
Name:KOZMAN, SAMIR A
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:A
Last Name:KOZMAN
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 1:901 N FEDERAL HWY # 1
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-3537
Mailing Address - Country:US
Mailing Address - Phone:954-342-4994
Mailing Address - Fax:954-342-4999
Practice Address - Street 1:901 N FEDERAL HWY # 1
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-3537
Practice Address - Country:US
Practice Address - Phone:954-342-4994
Practice Address - Fax:954-342-4999
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56120183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist