Provider Demographics
NPI:1457629594
Name:KRYNSKI, PAUL E
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:KRYNSKI
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 1:16241 S FARRELL RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-8101
Mailing Address - Country:US
Mailing Address - Phone:815-836-3422
Mailing Address - Fax:
Practice Address - Street 1:16241 S FARRELL RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-8101
Practice Address - Country:US
Practice Address - Phone:815-836-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023476A183500000X
IL051038365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist