Provider Demographics
NPI:1306477880
Name:ROZANSKI, EDWARD ADAM (RPH)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ADAM
Last Name:ROZANSKI
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 1:5277 LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-1422
Mailing Address - Country:US
Mailing Address - Phone:810-984-8200
Mailing Address - Fax:810-984-1633
Practice Address - Street 1:5277 LAPEER RD
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074-1422
Practice Address - Country:US
Practice Address - Phone:810-984-8200
Practice Address - Fax:810-984-1633
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist