Provider Demographics
NPI:1902189467
Name:BOLZAN, ENZO (PHARMD)
Entity Type:Individual
Prefix:
First Name:ENZO
Middle Name:
Last Name:BOLZAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 TREEWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-2591
Mailing Address - Country:US
Mailing Address - Phone:216-957-9063
Mailing Address - Fax:216-957-9191
Practice Address - Street 1:9200 TREEWORTH BLVD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-2591
Practice Address - Country:US
Practice Address - Phone:216-957-9063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03227967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist