Provider Demographics
NPI:1104438910
Name:SZCZECINSKI, JAIMIE M
Entity type:Individual
Prefix:
First Name:JAIMIE
Middle Name:M
Last Name:SZCZECINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 171ST ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-2287
Mailing Address - Country:US
Mailing Address - Phone:708-429-3324
Mailing Address - Fax:708-429-0996
Practice Address - Street 1:8400 171ST ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-2287
Practice Address - Country:US
Practice Address - Phone:708-429-3324
Practice Address - Fax:708-429-0996
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.299817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist