Provider Demographics
NPI:1164821971
Name:CZARNECKI, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CZARNECKI
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 1:35250 S GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2843
Mailing Address - Country:US
Mailing Address - Phone:586-791-1550
Mailing Address - Fax:586-792-3668
Practice Address - Street 1:35250 S GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-2843
Practice Address - Country:US
Practice Address - Phone:586-791-1550
Practice Address - Fax:586-792-3668
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist