Provider Demographics
NPI:1376861666
Name:GRZECZKA, GARY MICHAEL
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MICHAEL
Last Name:GRZECZKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 BANKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-2757
Mailing Address - Country:US
Mailing Address - Phone:412-388-1601
Mailing Address - Fax:412-563-0697
Practice Address - Street 1:3210 BANKSVILLE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-2757
Practice Address - Country:US
Practice Address - Phone:412-388-1601
Practice Address - Fax:412-563-0697
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037085R183500000X
WVRP0004745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist