Healthcare Provider Details

I. General information

NPI: 1821210154
Provider Name (Legal Business Name): LEON DONALD PACZKOWSKI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 BURRELL AVE.
COOPERSTOWN ND
58425-0627
US

IV. Provider business mailing address

PO BOX 602
COOPERSTOWN ND
58425-0602
US

V. Phone/Fax

Practice location:
  • Phone: 701-797-2414
  • Fax: 701-797-3456
Mailing address:
  • Phone: 701-797-2414
  • Fax: 701-797-3456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3227
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: