Provider Demographics
NPI:1407522816
Name:COZARIUC, PHILLIP (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:COZARIUC
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 W MAIN ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1478
Mailing Address - Country:US
Mailing Address - Phone:847-502-4618
Mailing Address - Fax:
Practice Address - Street 1:3608 S LAFOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3809
Practice Address - Country:US
Practice Address - Phone:765-455-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029428A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist