Provider Demographics
NPI:1083908230
Name:KOLENCIK, LEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:LEN
Middle Name:
Last Name:KOLENCIK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14070 CEDAR RD
Mailing Address - Street 2:T-1804
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3216
Mailing Address - Country:US
Mailing Address - Phone:216-416-0026
Mailing Address - Fax:216-416-0026
Practice Address - Street 1:14070 CEDAR RD
Practice Address - Street 2:T-1804
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3216
Practice Address - Country:US
Practice Address - Phone:216-416-0026
Practice Address - Fax:216-416-0026
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03324244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist