=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174792394
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS CHMIELEWSKI JR. PHARM D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2008
-----------------------------------------------------
Last Update Date | 11/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 657 HAMLIN HIGHWAY
-----------------------------------------------------
City | HAMLIN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18427-1842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-689-5011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 BEVERLEY RD
-----------------------------------------------------
City | EYNON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18403-1257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-689-5011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP440977
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------