Provider Demographics
NPI:1225387608
Name:KWIATEK, JUSTIN JOSEPH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JOSEPH
Last Name:KWIATEK
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 1:601 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 W VIRGINIA DR.
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:19034-0000
Practice Address - Country:US
Practice Address - Phone:609-897-2585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03513300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist