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General NPI Number Information
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NPI Number | 1841252772
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Entity Type | Organization
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Legal Business Name | WALTER CWIETNIEWICZ
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 2441 BROWN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1931
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Country | US
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Telephone | 215-765-1903
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Fax | 215-236-6606
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Provider Business Mailing Address
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Address Line | 2441 BROWN ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1931
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Country | US
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Telephone | 215-765-1903
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Fax | 215-236-6606
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Authorized Official
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Title or Position | RPH/PROP
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Name | WALTER CWIETNIEWICZ
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Credential | BS
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Telephone | 215-765-1903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP410688L
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License Number State | PA
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