Provider Demographics
NPI:1245616200
Name:ZELENKA, MARK ANDREW (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:ZELENKA
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 1:345 W VERNON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1045
Mailing Address - Country:US
Mailing Address - Phone:480-332-2821
Mailing Address - Fax:
Practice Address - Street 1:5771 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4635
Practice Address - Country:US
Practice Address - Phone:602-978-4998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist