Provider Demographics
NPI:1861744468
Name:GRUSZYNSKI, JASON JOHN (RPH)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:JOHN
Last Name:GRUSZYNSKI
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:N8274 OAK LN
Mailing Address - Street 2:
Mailing Address - City:CRIVITZ
Mailing Address - State:WI
Mailing Address - Zip Code:54114-7603
Mailing Address - Country:US
Mailing Address - Phone:715-663-0618
Mailing Address - Fax:
Practice Address - Street 1:3215 8TH ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-6564
Practice Address - Country:US
Practice Address - Phone:715-423-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1312740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist