Provider Demographics
NPI:1093251944
Name:BRYWCZYNSKI, ELISSA (PHARM D, RPH)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:BRYWCZYNSKI
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:OH
Mailing Address - Zip Code:43515-1420
Mailing Address - Country:US
Mailing Address - Phone:419-822-0306
Mailing Address - Fax:
Practice Address - Street 1:702 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:OH
Practice Address - Zip Code:43515-1420
Practice Address - Country:US
Practice Address - Phone:419-822-0306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03328840183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist