Provider Demographics
NPI:1154949675
Name:NIESZCZUR, ALEXIS MICHELLE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MICHELLE
Last Name:NIESZCZUR
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5447 WATERFORD CIR
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-0620
Mailing Address - Country:US
Mailing Address - Phone:440-334-8975
Mailing Address - Fax:
Practice Address - Street 1:5350 LEAVITT RD
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2158
Practice Address - Country:US
Practice Address - Phone:440-538-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist