Healthcare Provider Details

I. General information

NPI: 1447626585
Provider Name (Legal Business Name): ADAM KOWALCZYK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TECHNOLOGY CENTER DR
STOUGHTON MA
02072-4710
US

IV. Provider business mailing address

1547 TONAWANDA CREEK RD
BUFFALO NY
14228-1243
US

V. Phone/Fax

Practice location:
  • Phone: 781-566-5066
  • Fax:
Mailing address:
  • Phone: 716-432-5372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number061555
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202214327
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: