Provider Demographics
NPI:1669757050
Name:VALENCIC, BOZENA (PHRAM D)
Entity type:Individual
Prefix:MRS
First Name:BOZENA
Middle Name:
Last Name:VALENCIC
Suffix:
Gender:F
Credentials:PHRAM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 E PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1529
Mailing Address - Country:US
Mailing Address - Phone:203-637-1496
Mailing Address - Fax:
Practice Address - Street 1:1333 EAST PUTNAM AVENUE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878
Practice Address - Country:US
Practice Address - Phone:203-637-1496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0010111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist