Provider Demographics
NPI:1629238803
Name:STANCZAK, SUZANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:STANCZAK
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 1:1504 NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-1938
Mailing Address - Country:US
Mailing Address - Phone:413-533-7983
Mailing Address - Fax:413-533-4674
Practice Address - Street 1:1504 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-1938
Practice Address - Country:US
Practice Address - Phone:413-533-7983
Practice Address - Fax:413-533-4674
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist