Provider Demographics
NPI:1427565464
Name:WIECZOREK, ABBEY CHRISTINE (PHARMD)
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:CHRISTINE
Last Name:WIECZOREK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26603 393RD AVE
Mailing Address - Street 2:
Mailing Address - City:STICKNEY
Mailing Address - State:SD
Mailing Address - Zip Code:57375-6220
Mailing Address - Country:US
Mailing Address - Phone:507-402-4472
Mailing Address - Fax:
Practice Address - Street 1:1101 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4867
Practice Address - Country:US
Practice Address - Phone:605-995-6845
Practice Address - Fax:605-995-6857
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6479183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist