Healthcare Provider Details

I. General information

NPI: 1205921137
Provider Name (Legal Business Name): THOMAS PAUL KUJAWA R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BUNKER HILL DR
AITKIN MN
56431-1865
US

IV. Provider business mailing address

40389 303RD LN
AITKIN MN
56431-4534
US

V. Phone/Fax

Practice location:
  • Phone: 218-927-5588
  • Fax: 218-927-5551
Mailing address:
  • Phone: 218-927-3996
  • Fax: 218-927-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number113299-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: