Provider Demographics
NPI:1568880763
Name:SZCZEBAK, WOJCIECH
Entity Type:Individual
Prefix:
First Name:WOJCIECH
Middle Name:
Last Name:SZCZEBAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28635 N NORTH VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-5434
Mailing Address - Country:US
Mailing Address - Phone:623-582-9207
Mailing Address - Fax:623-582-2326
Practice Address - Street 1:28635 N NORTH VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-5434
Practice Address - Country:US
Practice Address - Phone:623-582-9207
Practice Address - Fax:623-582-2326
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist