Provider Demographics
NPI:1972783280
Name:LACZYNSKI, JOHN J (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:LACZYNSKI
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 1:351 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1258
Mailing Address - Country:US
Mailing Address - Phone:518-822-0076
Mailing Address - Fax:518-822-0078
Practice Address - Street 1:351 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1258
Practice Address - Country:US
Practice Address - Phone:518-822-0076
Practice Address - Fax:518-822-0078
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist