Provider Demographics
NPI:1447797139
Name:PUSZKA, JOANNA MALGORZATA (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:JOANNA
Middle Name:MALGORZATA
Last Name:PUSZKA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 EMERALD BAY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6210
Mailing Address - Country:US
Mailing Address - Phone:303-621-5831
Mailing Address - Fax:
Practice Address - Street 1:1043 EMERALD BAY RD
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6210
Practice Address - Country:US
Practice Address - Phone:303-621-5831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist