MEDICARE: CHESTER G KACZOR PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP0006907	WV
2	183500000X	Pharmacist	03-1-27410	OH

General Provider Information

NPI Number	:	1023145620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHESTER G KACZOR PHARM.D.

Provider Business Mailing Address
First Line	:	1280 SPRING VALLEY DR
Second Line	:	APARTMENT # 8
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-4300
Country	:	US
Telephone Number	:	567-204-5050
Fax Number	:

Provider Business Practice Location Address
First Line	:	4749 ROUTE 152
Second Line	:
City	:	LAVALETTE
State	:	WV
Zip	:	25535-9703
Country	:	US
Telephone Number	:	304-525-3992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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