Provider Demographics
NPI:1194052712
Name:DRABCZUK, GARY STEPHEN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:STEPHEN
Last Name:DRABCZUK
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14820 RUE DE BAYONNE APT 408
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-3030
Mailing Address - Country:US
Mailing Address - Phone:214-405-7114
Mailing Address - Fax:
Practice Address - Street 1:8001 9TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4109
Practice Address - Country:US
Practice Address - Phone:727-577-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44473183500000X
MA1067119183500000X
TX40670183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1194052712Medicaid