Healthcare Provider Details

I. General information

NPI: 1891786398
Provider Name (Legal Business Name): MR. JAMES MICHAEL ZUCHOWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 OLD NATIONAL PIKE
FREDERICKTOWN PA
15333-2114
US

IV. Provider business mailing address

1070 OLD NATIONAL PIKE
FREDERICKTOWN PA
15333-2114
US

V. Phone/Fax

Practice location:
  • Phone: 724-632-6801
  • Fax:
Mailing address:
  • Phone: 724-632-6801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP030885L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: