Provider Demographics
NPI:1154953313
Name:STUDNICKI, THADDEUS JOSEPH (RPH)
Entity type:Individual
Prefix:MR
First Name:THADDEUS
Middle Name:JOSEPH
Last Name:STUDNICKI
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 1:7960 COOLEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-4184
Mailing Address - Country:US
Mailing Address - Phone:248-366-3101
Mailing Address - Fax:
Practice Address - Street 1:7960 COOLEY LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-4184
Practice Address - Country:US
Practice Address - Phone:248-366-3101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist