Provider Demographics
NPI:1629494844
Name:YAGODZINSKI, MARK DAVID (PHARM D)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:YAGODZINSKI
Suffix:
Gender:M
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 1:1413 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2531
Mailing Address - Country:US
Mailing Address - Phone:859-240-2635
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY DRIVE C
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15240-1000
Practice Address - Country:US
Practice Address - Phone:412-360-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 50281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist