Provider Demographics
NPI:1073881132
Name:GRZESIK, MARIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:GRZESIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 E ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7840
Mailing Address - Country:US
Mailing Address - Phone:303-663-6858
Mailing Address - Fax:
Practice Address - Street 1:14 E ALLEN ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7840
Practice Address - Country:US
Practice Address - Phone:303-663-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist