Provider Demographics
NPI:1154745776
Name:VON CZERNIEWICZ, STEPHEN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:VON CZERNIEWICZ
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-1208
Mailing Address - Country:US
Mailing Address - Phone:516-593-7452
Mailing Address - Fax:
Practice Address - Street 1:488 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1208
Practice Address - Country:US
Practice Address - Phone:516-593-7452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0589371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist