Provider Demographics
NPI:1346589108
Name:MONCZNIK, PERRY (RPH)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:
Last Name:MONCZNIK
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 1:28754 KIRKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2656
Mailing Address - Country:US
Mailing Address - Phone:248-489-8076
Mailing Address - Fax:
Practice Address - Street 1:28754 KIRKSIDE LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2656
Practice Address - Country:US
Practice Address - Phone:248-489-8076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist