Provider Demographics
NPI:1154760593
Name:GOZDZIAK, KRZYSZTOF (RPH)
Entity type:Individual
Prefix:
First Name:KRZYSZTOF
Middle Name:
Last Name:GOZDZIAK
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 1:87 DOVER PKWY
Mailing Address - Street 2:87 DOVER PKWY
Mailing Address - City:STEWART MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3805
Mailing Address - Country:US
Mailing Address - Phone:516-437-5435
Mailing Address - Fax:
Practice Address - Street 1:87 DOVER PKWY
Practice Address - Street 2:
Practice Address - City:STEWART MANOR
Practice Address - State:NY
Practice Address - Zip Code:11530-3805
Practice Address - Country:US
Practice Address - Phone:516-437-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032189OtherPHARMACIST