Provider Demographics
NPI:1740442391
Name:BOGDANOWICZ, ERIC JOSEPH (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JOSEPH
Last Name:BOGDANOWICZ
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TIMBER LN
Mailing Address - Street 2:
Mailing Address - City:LAKE GEORGE
Mailing Address - State:NY
Mailing Address - Zip Code:12845-6407
Mailing Address - Country:US
Mailing Address - Phone:518-668-3874
Mailing Address - Fax:
Practice Address - Street 1:939 ROUTE 146
Practice Address - Street 2:BUILDING 600
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3662
Practice Address - Country:US
Practice Address - Phone:518-383-4517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist