Provider Demographics
NPI:1619493061
Name:KOZLIK, AMANDA MARIE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:KOZLIK
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WARE
Mailing Address - State:MA
Mailing Address - Zip Code:01082-9517
Mailing Address - Country:US
Mailing Address - Phone:413-658-8555
Mailing Address - Fax:
Practice Address - Street 1:707 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-4109
Practice Address - Country:US
Practice Address - Phone:413-731-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH237582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist