Provider Demographics
NPI:1508975764
Name:PUCYLOWSKI, KRISTY L (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:L
Last Name:PUCYLOWSKI
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 FAIRWAY OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3519
Mailing Address - Country:US
Mailing Address - Phone:678-236-0400
Mailing Address - Fax:678-236-0404
Practice Address - Street 1:4469 LEMON ST
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5418
Practice Address - Country:US
Practice Address - Phone:678-236-0400
Practice Address - Fax:678-236-0404
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist