Provider Demographics
NPI:1003908633
Name:CZAJKA, WALTER JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:JOSEPH
Last Name:CZAJKA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ELM STR
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571
Mailing Address - Country:US
Mailing Address - Phone:845-758-3223
Mailing Address - Fax:845-876-0466
Practice Address - Street 1:18 EAST MARKET STR
Practice Address - Street 2:NORTHERN DUTCHESS PHARMACY INC
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572
Practice Address - Country:US
Practice Address - Phone:845-876-3939
Practice Address - Fax:845-876-0466
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist