Provider Demographics
NPI:1619191061
Name:SZULCZEWSKI, DON (RPH)
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:
Last Name:SZULCZEWSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 S HEARTH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-9254
Mailing Address - Country:US
Mailing Address - Phone:262-789-0211
Mailing Address - Fax:414-805-6513
Practice Address - Street 1:FROEDTERT HOSPITAL
Practice Address - Street 2:9200 W WISCONSIN AVE
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-805-6501
Practice Address - Fax:414-805-6513
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9612-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6124134OtherNABP NUMBER
WI33209900Medicaid