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General NPI Number Information
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NPI Number | 1790322501
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Entity Type | Individual
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Provider Name | MARK P KRAJEWSKI RPH
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Gender | Male
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Dates
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Enumeration Date | 11/30/2019
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Last Update Date | 11/30/2019
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Provider Practice Location Address
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Address Line | 2105 SOUTH BLVD W
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City | TROY
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State | MI
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Zip | 48098-6539
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Country | US
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Telephone | 248-792-4192
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Fax |
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Provider Business Mailing Address
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Address Line | 5230 CAMERON CT
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City | TROY
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State | MI
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Zip | 48098-2414
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Country | US
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Telephone | 248-792-4192
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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 | 5302025990
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License Number State | MI
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