Healthcare Provider Details

I. General information

NPI: 1356004022
Provider Name (Legal Business Name): DAVID WOJCIAK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 BIDDULPH RD
BROOKLYN OH
44144-3347
US

IV. Provider business mailing address

3846 BOXELDER DR
BRECKSVILLE OH
44141-2580
US

V. Phone/Fax

Practice location:
  • Phone: 216-739-4125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03212801
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: