Provider Demographics
NPI:1417535352
Name:OLCZYK, SAMUEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:OLCZYK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3262 WATKINS RD APT 2B
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-8580
Mailing Address - Country:US
Mailing Address - Phone:315-941-1775
Mailing Address - Fax:
Practice Address - Street 1:2144 GRAND CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8260
Practice Address - Country:US
Practice Address - Phone:607-739-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI067693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist