Provider Demographics
NPI:1295010270
Name:KRZMARZICK, ROBERT LEE (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:KRZMARZICK
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 1:8240 FLYING CLOUD DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5316
Mailing Address - Country:US
Mailing Address - Phone:952-252-1112
Mailing Address - Fax:
Practice Address - Street 1:5949 FAIRWOOD LN
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-6534
Practice Address - Country:US
Practice Address - Phone:952-934-4598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111785183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist