Provider Demographics
NPI:1538682133
Name:DZIELSKI, JOSHUA (RPH)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:DZIELSKI
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 1:627 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-5103
Mailing Address - Country:US
Mailing Address - Phone:304-366-4526
Mailing Address - Fax:
Practice Address - Street 1:627 FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-5103
Practice Address - Country:US
Practice Address - Phone:304-366-4526
Practice Address - Fax:304-366-4508
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0010216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVRP0010219OtherRPH LICENSE