Provider Demographics
NPI:1558915959
Name:PRZYBYSZ, KELLY (CPHT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:PRZYBYSZ
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 DALLING DR
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43619-2030
Mailing Address - Country:US
Mailing Address - Phone:419-490-0995
Mailing Address - Fax:
Practice Address - Street 1:3961 DALLING DR
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43619-2030
Practice Address - Country:US
Practice Address - Phone:419-490-0995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RW03773700183700000X
DCPT01337183700000X
TX296446183700000X
OH09303624183700000X
NVPT22338183700000X
MI5303023659183700000X
VA0230033821183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician