Provider Demographics
NPI:1427397207
Name:GRUSZYNSKI, EZRA (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:EZRA
Middle Name:
Last Name:GRUSZYNSKI
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 1:710 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CRIVITZ
Mailing Address - State:WI
Mailing Address - Zip Code:54114-1664
Mailing Address - Country:US
Mailing Address - Phone:715-854-7425
Mailing Address - Fax:715-854-7326
Practice Address - Street 1:710 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CRIVITZ
Practice Address - State:WI
Practice Address - Zip Code:54114-1664
Practice Address - Country:US
Practice Address - Phone:715-854-7425
Practice Address - Fax:715-854-7326
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13458-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist