MEDICARE: ALEXANDER KOWALCZYK

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	28RI03965700	NJ

General Provider Information

NPI Number	:	1609351238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER KOWALCZYK

Provider Business Mailing Address
First Line	:	76 DOUBLE CREEK PKWY
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-3013
Country	:	US
Telephone Number	:	732-865-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 ROUTE 37 E
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-5375
Country	:	US
Telephone Number	:	732-341-0022
Fax Number	:

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

Provider Enumeration Date	:	09/28/2018
Last Update Date	:	09/28/2018

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Directions to “ ALEXANDER KOWALCZYK ” Practice Location

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