MEDICARE: MRS. MARY ANN CZUCZAK RP

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	28R101418000	NJ

General Provider Information

NPI Number	:	1386736072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ANN CZUCZAK RP

Provider Business Mailing Address
First Line	:	51 STANLEY AVE
Second Line	:
City	:	DAYTON
State	:	NJ
Zip	:	08810-1352
Country	:	US
Telephone Number	:	732-329-2678
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 PLAINFIELD AVE
Second Line	:
City	:	PISCATAWAY
State	:	NJ
Zip	:	08854-4046
Country	:	US
Telephone Number	:	732-885-1000
Fax Number	:	732-981-0357

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/08/2007

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