Provider Demographics
NPI:1245408178
Name:NYCZ, JOHN T (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:NYCZ
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 1:193 HADDENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3942
Mailing Address - Country:US
Mailing Address - Phone:973-614-0807
Mailing Address - Fax:
Practice Address - Street 1:405 US ROUTE 17
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-487-0145
Practice Address - Fax:201-525-1252
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI17305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJRI17305OtherSTATE RPH LIC #