Provider Demographics
NPI:1104366020
Name:MIERZWA, MARK (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MIERZWA
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 1:45-710 KEAAHALA RD
Mailing Address - Street 2:BUILDING G - PHARMACY
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3528
Mailing Address - Country:US
Mailing Address - Phone:808-236-8350
Mailing Address - Fax:808-247-2037
Practice Address - Street 1:45-710 KEAAHALA RD
Practice Address - Street 2:BUILDING G - PHARMACY
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3528
Practice Address - Country:US
Practice Address - Phone:808-236-8350
Practice Address - Fax:808-247-2037
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH 21321835P1300X
NJ28RI027586001835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric