Healthcare Provider Details

I. General information

NPI: 1619191061
Provider Name (Legal Business Name): DON SZULCZEWSKI RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FROEDTERT HOSPITAL 9200 W WISCONSIN AVE
WAUWATOSA WI
53226
US

IV. Provider business mailing address

4685 S HEARTH RIDGE DR
NEW BERLIN WI
53151-9254
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-6501
  • Fax: 414-805-6513
Mailing address:
  • Phone: 262-789-0211
  • Fax: 414-805-6513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9612-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: