Provider Demographics
NPI:1083330864
Name:KULCZYCKI, NOAH
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:KULCZYCKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44292 THUNDER BAY DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1395
Mailing Address - Country:US
Mailing Address - Phone:586-431-0335
Mailing Address - Fax:
Practice Address - Street 1:44292 THUNDER BAY DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1395
Practice Address - Country:US
Practice Address - Phone:586-431-0335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist