Provider Demographics
NPI:1417472309
Name:MOTYCKA, JOSEPH E
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:E
Last Name:MOTYCKA
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 1:37 S HIGHLAND AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303
Mailing Address - Country:US
Mailing Address - Phone:419-230-9980
Mailing Address - Fax:
Practice Address - Street 1:37 S HIGHLAND AVE
Practice Address - Street 2:APT 1
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-4430
Practice Address - Country:US
Practice Address - Phone:419-230-9980
Practice Address - Fax:419-230-9980
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03237471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist