Healthcare Provider Details

I. General information

NPI: 1144433525
Provider Name (Legal Business Name): PETERF J KWASNIK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

212 STONE HOUSE RD
SHERBURNE NY
13460
US

IV. Provider business mailing address

38 SOUTH BROAD STREET
NORWICH NY
13815
US

V. Phone/Fax

Practice location:
  • Phone: 607-334-2431
  • Fax:
Mailing address:
  • Phone: 607-334-2431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26287
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: