Healthcare Provider Details

I. General information

NPI: 1174432918
Provider Name (Legal Business Name): KYLE MATTHEW CHOJNACKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 PULASKI HWY
HAVRE DE GRACE MD
21078-2601
US

IV. Provider business mailing address

943 PULASKI HWY
HAVRE DE GRACE MD
21078-2601
US

V. Phone/Fax

Practice location:
  • Phone: 410-939-4282
  • Fax:
Mailing address:
  • Phone: 410-939-4282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberT32779
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: