Provider Demographics
NPI:1891169678
Name:KOZOWYK, ERINIE
Entity Type:Individual
Prefix:
First Name:ERINIE
Middle Name:
Last Name:KOZOWYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COMMERCE WAY
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1007
Mailing Address - Country:US
Mailing Address - Phone:781-904-0003
Mailing Address - Fax:
Practice Address - Street 1:101 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1007
Practice Address - Country:US
Practice Address - Phone:781-904-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH236251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist