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General NPI Number Information
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NPI Number | 1316576465
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Entity Type | Individual
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Provider Name | ELIZABETH ANNE BAJCZYK PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 2401 COULEE RD
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City | HUDSON
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State | WI
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Zip | 54016-2183
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Country | US
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Telephone | 715-381-3603
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 PHILLIPS PKWY APT 208
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City | SAINT LOUIS PARK
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State | MN
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Zip | 55426-3875
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Country | US
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Telephone | 218-251-7176
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 20080-40
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 124439
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License Number State | MN
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