Provider Demographics
NPI:1558637744
Name:GRZYBOWSKI, KEVIN P (PHARMD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:GRZYBOWSKI
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 1:5546 POWERS RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3111
Mailing Address - Country:US
Mailing Address - Phone:716-348-4103
Mailing Address - Fax:
Practice Address - Street 1:10401 BENNETT RD
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1402
Practice Address - Country:US
Practice Address - Phone:716-679-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-01
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056590-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist