Provider Demographics
NPI:1578864799
Name:KALAMON, WOJCIECH
Entity Type:Individual
Prefix:MR
First Name:WOJCIECH
Middle Name:
Last Name:KALAMON
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 1:609 OMACHE DR
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9672
Mailing Address - Country:US
Mailing Address - Phone:509-826-2806
Mailing Address - Fax:
Practice Address - Street 1:609 OMACHE DR
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9672
Practice Address - Country:US
Practice Address - Phone:509-826-2806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60157062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist