Healthcare Provider Details

I. General information

NPI: 1255646550
Provider Name (Legal Business Name): DAVID WOJTCZAK R.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MAIN STREET
WILMINGTON MA
01887-2341
US

IV. Provider business mailing address

5 SOUTH HILLSIDE STREET
STONEHAM MA
02180-2715
US

V. Phone/Fax

Practice location:
  • Phone: 978-988-0232
  • Fax: 978-988-1958
Mailing address:
  • Phone: 781-864-9227
  • Fax: 978-988-1058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberMA25757
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: