Provider Demographics
NPI:1134306699
Name:SZYMCZAK, SCOTT J (RPH)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:J
Last Name:SZYMCZAK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEADOW HILL LN
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-5482
Mailing Address - Country:US
Mailing Address - Phone:718-886-6645
Mailing Address - Fax:
Practice Address - Street 1:100 MEADOW HILL LN
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-5482
Practice Address - Country:US
Practice Address - Phone:718-886-6645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047571183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist