Provider Demographics
NPI:1255484614
Name:ZAJKOWSKI, JAMES HENRY (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:HENRY
Last Name:ZAJKOWSKI
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 1:110 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-1722
Mailing Address - Country:US
Mailing Address - Phone:715-246-2186
Mailing Address - Fax:715-246-7115
Practice Address - Street 1:110 W 4TH ST
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1722
Practice Address - Country:US
Practice Address - Phone:715-246-2186
Practice Address - Fax:715-246-7115
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist