MEDICARE: GREGORY SYLVESTER KUZNIEWSKI 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	8895-40	WI

General Provider Information

NPI Number	:	1942577630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY SYLVESTER KUZNIEWSKI RPH

Provider Business Mailing Address
First Line	:	6210 W LOOMIS RD
Second Line	:
City	:	GREENDALE
State	:	WI
Zip	:	53129-2448
Country	:	US
Telephone Number	:	414-423-1485
Fax Number	:	414-423-4479

Provider Business Practice Location Address
First Line	:	6210 W LOOMIS RD
Second Line	:
City	:	GREENDALE
State	:	WI
Zip	:	53129-2448
Country	:	US
Telephone Number	:	414-423-1485
Fax Number	:	414-423-4479

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

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	11/22/2011

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