Provider Demographics
NPI:1558629436
Name:KUDLAWIEC, BRYAN ROBERT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:ROBERT
Last Name:KUDLAWIEC
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 HOWARD AVE
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601
Mailing Address - Country:US
Mailing Address - Phone:814-889-2322
Mailing Address - Fax:814-889-7926
Practice Address - Street 1:620 HOWARD AVE
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4804
Practice Address - Country:US
Practice Address - Phone:814-889-2322
Practice Address - Fax:814-889-7926
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist