Provider Demographics
NPI:1265774442
Name:BOZEMAN, CAROLINE ANN (RPH)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ANN
Last Name:BOZEMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4421 CRESWELL AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-1631
Mailing Address - Country:US
Mailing Address - Phone:318-868-4411
Mailing Address - Fax:
Practice Address - Street 1:2551 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3981
Practice Address - Country:US
Practice Address - Phone:318-631-2005
Practice Address - Fax:318-631-1883
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist