Provider Demographics
NPI:1619200169
Name:PAWLUCZUK, JOANNA K (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:K
Last Name:PAWLUCZUK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1044
Mailing Address - Country:US
Mailing Address - Phone:718-235-7041
Mailing Address - Fax:
Practice Address - Street 1:1242 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1044
Practice Address - Country:US
Practice Address - Phone:718-235-7041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist