Provider Demographics
NPI:1003391574
Name:BUDZYNSKI, STANLEY JOHN (PHARMD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:JOHN
Last Name:BUDZYNSKI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:STANLEY
Other - Middle Name:JOHN
Other - Last Name:BUDZYNSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:14837 INNISBROOK LN
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-5950
Mailing Address - Country:US
Mailing Address - Phone:773-507-6219
Mailing Address - Fax:
Practice Address - Street 1:1019 W SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1966
Practice Address - Country:US
Practice Address - Phone:517-374-6103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302046165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist