MEDICARE: KEVIN KRUPCZAK

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	PH239741	MA

General Provider Information

NPI Number	:	1992391304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN KRUPCZAK

Provider Business Mailing Address
First Line	:	194 BEEKMAN DR
Second Line	:
City	:	AGAWAM
State	:	MA
Zip	:	01001-2605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1277 LIBERTY ST
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01104-1165
Country	:	US
Telephone Number	:	413-732-7040
Fax Number	:

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

Provider Enumeration Date	:	12/19/2020
Last Update Date	:	12/19/2020

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Directions to “ KEVIN KRUPCZAK ” Practice Location

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