Provider Demographics
NPI:1992832034
Name:BOKULIC, DEBRA W (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:W
Last Name:BOKULIC
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 STATE RD
Mailing Address - Street 2:PHARMACY DEPT
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-2439
Mailing Address - Country:US
Mailing Address - Phone:513-624-4668
Mailing Address - Fax:
Practice Address - Street 1:7500 STATE RD
Practice Address - Street 2:PHARMACY DEPT
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2439
Practice Address - Country:US
Practice Address - Phone:513-624-4668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist