MEDICARE: WALTER CWIETNIEWICZ

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PP410688L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2086924	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841252772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTER CWIETNIEWICZ

Provider Business Mailing Address
First Line	:	2441 BROWN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1931
Country	:	US
Telephone Number	:	215-765-1903
Fax Number	:	215-236-6606

Provider Business Practice Location Address
First Line	:	2441 BROWN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19130-1931
Country	:	US
Telephone Number	:	215-765-1903
Fax Number	:	215-236-6606

Authorized Official
Title or Position	:	RPH/PROP
Name	:	WALTER CWIETNIEWICZ
Credential	:	BS
Telephone Number	:	215-765-1903

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	03/01/2017

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