Provider Demographics
NPI:1326412842
Name:SZYMCZAK, JEFFRY A (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFRY
Middle Name:A
Last Name:SZYMCZAK
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 1:3296 SPRUCE CREEK GLN
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6867
Mailing Address - Country:US
Mailing Address - Phone:386-313-3952
Mailing Address - Fax:386-313-3962
Practice Address - Street 1:3296 SPRUCE CREEK GLN
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-6867
Practice Address - Country:US
Practice Address - Phone:386-313-3952
Practice Address - Fax:386-313-3962
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist