Provider Demographics
NPI:1962588590
Name:WIELGUS, JOZEF F (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:MR
First Name:JOZEF
Middle Name:F
Last Name:WIELGUS
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5139 N EAST RIVER RD
Mailing Address - Street 2:267C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-2681
Mailing Address - Country:US
Mailing Address - Phone:773-589-1092
Mailing Address - Fax:
Practice Address - Street 1:7124 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1904
Practice Address - Country:US
Practice Address - Phone:773-631-5333
Practice Address - Fax:773-763-1402
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician