Provider Demographics
NPI:1184034829
Name:KOWALCZUK, MARIA MAGDALENA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:MAGDALENA
Last Name:KOWALCZUK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17291 WETHERINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-5513
Mailing Address - Country:US
Mailing Address - Phone:317-804-5855
Mailing Address - Fax:
Practice Address - Street 1:17000 MERCANTILE BLVD
Practice Address - Street 2:MEIJER 230
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3941
Practice Address - Country:US
Practice Address - Phone:317-774-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-03
Last Update Date:2014-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26019507A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN26019507AOtherPHARMACIST LICENSE NUMBER