Healthcare Provider Details

I. General information

NPI: 1790920189
Provider Name (Legal Business Name): STASIA J WOJCIK PHARM. D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CAREW ST LOUIS AND CLARK DRUGSTORE
SPRINGFIELD MA
01104-2301
US

IV. Provider business mailing address

299 CAREW ST LOUIS AND CLARK DRUGSTORE
SPRINGFIELD MA
01104-2301
US

V. Phone/Fax

Practice location:
  • Phone: 413-731-0152
  • Fax: 413-734-5629
Mailing address:
  • Phone: 413-731-0152
  • Fax: 413-734-5629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25135
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: