Provider Demographics
NPI:1831462670
Name:BOZOVICH, MICHELLE BENNETT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:BENNETT
Last Name:BOZOVICH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HILLWIND CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3866
Mailing Address - Country:US
Mailing Address - Phone:336-540-1612
Mailing Address - Fax:
Practice Address - Street 1:301 E WENDOVER AVE STE 115
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1209
Practice Address - Country:US
Practice Address - Phone:336-272-7255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC125401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist