Provider Demographics
NPI:1629553276
Name:ZARZECKI, ALYSSA GENAVIVE
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:GENAVIVE
Last Name:ZARZECKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 RIVER ST APT 242
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3089
Mailing Address - Country:US
Mailing Address - Phone:443-703-8965
Mailing Address - Fax:
Practice Address - Street 1:1636 SANDIFER BLVD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0906
Practice Address - Country:US
Practice Address - Phone:864-885-0408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-29
Last Update Date:2018-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58508183500000X
MD25837183500000X
SC37911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist