Provider Demographics
NPI:1225805161
Name:CHOMICKI, ZACHARY (MS, RDN, CD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:CHOMICKI
Suffix:
Gender:M
Credentials:MS, RDN, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 GARDENIA LN SW APT 8-203
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6058
Mailing Address - Country:US
Mailing Address - Phone:414-736-4866
Mailing Address - Fax:
Practice Address - Street 1:3027 GARDENIA LN SW APT 8-203
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-6058
Practice Address - Country:US
Practice Address - Phone:414-736-4866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61513228133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered