Provider Demographics
NPI:1609150341
Name:KONDRATOWICZ, LYDIA ELIZABETH (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:ELIZABETH
Last Name:KONDRATOWICZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 ROBERTSON WAY
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1852
Mailing Address - Country:US
Mailing Address - Phone:973-740-1166
Mailing Address - Fax:
Practice Address - Street 1:45 S LIVINGSTON AVE # A
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3016
Practice Address - Country:US
Practice Address - Phone:973-740-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RJ00439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist