MEDICARE: JASON JOHN GRUSZYNSKI 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	1312740	WI

General Provider Information

NPI Number	:	1861744468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON JOHN GRUSZYNSKI RPH

Provider Business Mailing Address
First Line	:	N8274 OAK LN
Second Line	:
City	:	CRIVITZ
State	:	WI
Zip	:	54114-7603
Country	:	US
Telephone Number	:	715-663-0618
Fax Number	:

Provider Business Practice Location Address
First Line	:	3215 8TH ST S
Second Line	:
City	:	WISCONSIN RAPIDS
State	:	WI
Zip	:	54494-6564
Country	:	US
Telephone Number	:	715-423-3400
Fax Number	:

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

Provider Enumeration Date	:	10/05/2012
Last Update Date	:	10/05/2012

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