Provider Demographics
NPI:1063961225
Name:BOGDANOWICZ, BRIAN STANLEY (PHARMD, BCACP)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:STANLEY
Last Name:BOGDANOWICZ
Suffix:
Gender:M
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4046 W ABRAHAM LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4772
Mailing Address - Country:US
Mailing Address - Phone:815-412-4795
Mailing Address - Fax:
Practice Address - Street 1:15990 N GREENWAY HAYDEN LOOP STE D100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2269
Practice Address - Country:US
Practice Address - Phone:877-662-6633
Practice Address - Fax:877-662-6355
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist