Provider Demographics
NPI:1396018248
Name:DZIK, MARK FRANCIS (BSC PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:FRANCIS
Last Name:DZIK
Suffix:
Gender:M
Credentials:BSC PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9143 LADNER FARMS NE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8894
Mailing Address - Country:US
Mailing Address - Phone:616-874-3221
Mailing Address - Fax:
Practice Address - Street 1:4652 N M 37 HWY
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333-8806
Practice Address - Country:US
Practice Address - Phone:269-795-7936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032196183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist