Provider Demographics
NPI:1447240536
Name:CHLUDZINSKI, PAUL RICHARD (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:RICHARD
Last Name:CHLUDZINSKI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34148 GROVE DR
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2522
Mailing Address - Country:US
Mailing Address - Phone:734-591-1306
Mailing Address - Fax:
Practice Address - Street 1:24555 HAIG ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3322
Practice Address - Country:US
Practice Address - Phone:313-292-6260
Practice Address - Fax:313-291-3465
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist