Provider Demographics
NPI:1639499908
Name:DZIECHCIARZ, IRENE DIANE (RPH)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:DIANE
Last Name:DZIECHCIARZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15250 24 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-5817
Mailing Address - Country:US
Mailing Address - Phone:586-677-1108
Mailing Address - Fax:586-677-1129
Practice Address - Street 1:15250 24 MILE RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-5817
Practice Address - Country:US
Practice Address - Phone:586-677-1108
Practice Address - Fax:586-677-1129
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist