Provider Demographics
NPI:1033799655
Name:ADAMCZYK, THADDEUS (RPH)
Entity Type:Individual
Prefix:MR
First Name:THADDEUS
Middle Name:
Last Name:ADAMCZYK
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 1:105 TERHUNE AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-2805
Mailing Address - Country:US
Mailing Address - Phone:973-473-2243
Mailing Address - Fax:
Practice Address - Street 1:105 TERHUNE AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-2805
Practice Address - Country:US
Practice Address - Phone:973-473-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01527000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist