MEDICARE: DR. MICHELLE ANN KACZYNSKI PHARM D

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	S011228	AZ

General Provider Information

NPI Number	:	1912661257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE ANN KACZYNSKI PHARM D

Provider Business Mailing Address
First Line	:	4920 N CALLE BOSQUE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-6336
Country	:	US
Telephone Number	:	520-401-2935
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 E WETMORE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-1720
Country	:	US
Telephone Number	:	520-809-6518
Fax Number	:

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

Provider Enumeration Date	:	10/22/2021
Last Update Date	:	10/22/2021

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