Healthcare Provider Details

I. General information

NPI: 1477428811
Provider Name (Legal Business Name): SCOTT BONCZEK PHARMD RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FRONT ST
WORCESTER MA
01608-1425
US

IV. Provider business mailing address

63 AUBURN RD
WEST HARTFORD CT
06119-1304
US

V. Phone/Fax

Practice location:
  • Phone: 508-460-3129
  • Fax:
Mailing address:
  • Phone: 860-302-3092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH241304
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0011342
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: