Provider Demographics
NPI:1477822781
Name:KOLODIEJ, ALAN M (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:M
Last Name:KOLODIEJ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-4504
Mailing Address - Country:US
Mailing Address - Phone:219-874-2544
Mailing Address - Fax:219-878-0165
Practice Address - Street 1:1816 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-4504
Practice Address - Country:US
Practice Address - Phone:219-874-2544
Practice Address - Fax:219-878-0165
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013586A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist