MEDICARE: MR. DALE A ADAMCZYK 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	10046-40	WI

General Provider Information

NPI Number	:	1730597972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DALE A ADAMCZYK RPH

Provider Business Mailing Address
First Line	:	2414 10TH AVE
Second Line	:
City	:	SOUTH MILWAUKEE
State	:	WI
Zip	:	53172-2507
Country	:	US
Telephone Number	:	414-762-2610
Fax Number	:	414-571-4130

Provider Business Practice Location Address
First Line	:	2414 10TH AVE
Second Line	:
City	:	SOUTH MILWAUKEE
State	:	WI
Zip	:	53172-2507
Country	:	US
Telephone Number	:	414-762-2610
Fax Number	:	414-571-4130

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

Provider Enumeration Date	:	07/31/2014
Last Update Date	:	07/31/2014

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