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NPI Code Detail

MEDICARE: MR. JOHN MICHAEL GWIAZDA R.PH

MEDICARE: MR. JOHN MICHAEL GWIAZDA R.PH
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
1183500000XPharmacist053415NY
2183500000XPharmacist28RI01393600NJ

General Provider Information

NPI Number : 1790017994
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN MICHAEL GWIAZDA R.PH
Provider Business Mailing Address
First Line : PO BOX 185
Second Line :
City : GREENPORT
State : NY
Zip : 11944-0185
Country : US
Telephone Number : 516-446-6050
Fax Number : 631-477-3416
Provider Business Practice Location Address
First Line : 111 MAIN ST
Second Line :
City : SOUTHAMPTON
State : NY
Zip : 11968-4810
Country : US
Telephone Number : 631-283-4251
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2010
Last Update Date : 02/12/2010

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