Healthcare Provider Details

I. General information

NPI: 1659850543
Provider Name (Legal Business Name): MICHAEL JOSEPH KOWALCZYK PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3871 CENTER RD
BRUNSWICK OH
44212-3058
US

IV. Provider business mailing address

19202 SARATOGA TRL
STRONGSVILLE OH
44136-7259
US

V. Phone/Fax

Practice location:
  • Phone: 330-220-7767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03338340
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: