Provider Demographics
NPI:1346530813
Name:KAWULOK, STEVE (RPH)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:KAWULOK
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 1:750 23RD AVE E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-7804
Mailing Address - Country:US
Mailing Address - Phone:701-281-2222
Mailing Address - Fax:
Practice Address - Street 1:750 23RD AVE E
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-7804
Practice Address - Country:US
Practice Address - Phone:701-281-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist