Provider Demographics
NPI:1497254684
Name:KRAKOWIAK, ADAM THOMAS
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:THOMAS
Last Name:KRAKOWIAK
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 1:835 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2469
Mailing Address - Country:US
Mailing Address - Phone:860-242-5551
Mailing Address - Fax:
Practice Address - Street 1:835 PARK AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2469
Practice Address - Country:US
Practice Address - Phone:860-242-5551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239900183500000X
CTPCT.0014113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist