MEDICARE: MR. THEODORE J SAWULSKI RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	10859	AZ

General Provider Information

NPI Number	:	1316272529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THEODORE J SAWULSKI RPH

Provider Business Mailing Address
First Line	:	2133 E SKYLINE DR
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-6823
Country	:	US
Telephone Number	:	928-527-0250
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N SWITZER CANYON DR
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-4836
Country	:	US
Telephone Number	:	928-774-3389
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2009
Last Update Date	:	10/06/2009

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