Provider Demographics
NPI:1285161802
Name:BUGLEWICZ, JOHN DAVID (RPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:BUGLEWICZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 S PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2312
Mailing Address - Country:US
Mailing Address - Phone:719-561-4405
Mailing Address - Fax:719-561-0563
Practice Address - Street 1:1545 S PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2312
Practice Address - Country:US
Practice Address - Phone:719-561-4405
Practice Address - Fax:719-561-0563
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-13
Last Update Date:2017-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist