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General NPI Number Information
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NPI Number | 1841749009
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Entity Type | Individual
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Provider Name | LAWRENCE CZUBAK
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Gender | Male
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Dates
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Enumeration Date | 09/29/2016
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 2101 US 131
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City | KALKASKA
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State | MI
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Zip | 49646-8821
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Country | US
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Telephone | 231-258-9114
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Fax | 855-235-1321
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Provider Business Mailing Address
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Address Line | 2101 US 131
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City | KALKASKA
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State | MI
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Zip | 49646-8821
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Country | US
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Telephone | 231-258-9114
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Fax | 855-235-1321
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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 | 5302410482
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License Number State | MI
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