Healthcare Provider Details

I. General information

NPI: 1760729537
Provider Name (Legal Business Name): CHRIS KACZMARCZYK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2013
Last Update Date: 01/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13455 COUNTY LINE RD
SPRING HILL FL
34609-6600
US

IV. Provider business mailing address

13164 JESSICA DR
SPRING HILL FL
34609-9005
US

V. Phone/Fax

Practice location:
  • Phone: 352-797-8032
  • Fax: 352-797-8037
Mailing address:
  • Phone: 352-797-8032
  • Fax: 352-797-8037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS28054
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: