Healthcare Provider Details

I. General information

NPI: 1679178487
Provider Name (Legal Business Name): MARK CHESTER ZIELONKA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 STAFFORD ST
WORCESTER MA
01603-1440
US

IV. Provider business mailing address

5 DIGHTON ST
WORCESTER MA
01603-2206
US

V. Phone/Fax

Practice location:
  • Phone: 508-753-3297
  • Fax:
Mailing address:
  • Phone: 508-688-4691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH24012
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: