Provider Demographics
NPI:1568074680
Name:TARKOWSKA-SZUDY, KATARZYNA
Entity Type:Individual
Prefix:
First Name:KATARZYNA
Middle Name:
Last Name:TARKOWSKA-SZUDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 119TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:IN
Mailing Address - Zip Code:46394-1602
Mailing Address - Country:US
Mailing Address - Phone:219-659-0299
Mailing Address - Fax:
Practice Address - Street 1:1301 119TH ST
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IN
Practice Address - Zip Code:46394-1602
Practice Address - Country:US
Practice Address - Phone:219-659-0299
Practice Address - Fax:219-659-7660
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2602260A183500000X
IL051293158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN8435Other8435