Individual provider · NPI-1
Lucas Bozick
Pharmacy, Community/Retail Pharmacy · Tyler, TX
NPI number1023655255
StatusActive
Last updated in NPPESDec 6, 2019
Details
- NPI
- 1023655255
- Entity type
- Individual (NPI-1)
- Name
- Lucas Bozick
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Dec 6, 2019
- Last updated
- Dec 6, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | 50177 | TX | Yes |
Practice location
3828 Troup HwyTyler, TX 75703-1726
Phone 903-581-9666
Mailing address
3828 Troup HwyTyler, TX 75703-1726
Phone 903-581-9666
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