Provider Demographics
NPI:1528155389
Name:WOJDULA, PHILIP STEPHEN (RPH)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:STEPHEN
Last Name:WOJDULA
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 1:160 WARDS TRL
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935-8176
Mailing Address - Country:US
Mailing Address - Phone:906-367-7445
Mailing Address - Fax:
Practice Address - Street 1:160 WARDS TRL
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935-8176
Practice Address - Country:US
Practice Address - Phone:906-367-7445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist