Provider Demographics
NPI:1467041277
Name:PAZYNSKI, JOHN HENRY
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:PAZYNSKI
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 1:55066 N FISHER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-9038
Mailing Address - Country:US
Mailing Address - Phone:269-279-9416
Mailing Address - Fax:
Practice Address - Street 1:121 W PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MI
Practice Address - Zip Code:49097-1258
Practice Address - Country:US
Practice Address - Phone:269-649-0660
Practice Address - Fax:269-649-4755
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist