=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255646550
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID WOJTCZAK R.P.H.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2010
-----------------------------------------------------
Last Update Date | 08/11/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 208 MAIN STREET
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01887-2341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-988-0232
-----------------------------------------------------
Fax | 978-988-1958
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 SOUTH HILLSIDE STREET
-----------------------------------------------------
City | STONEHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02180-2715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-864-9227
-----------------------------------------------------
Fax | 978-988-1058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | MA25757
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------