Provider Demographics
NPI:1659735868
Name:DYMOWSKI, JOSEPH
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:DYMOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CHEWS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-3710
Mailing Address - Country:US
Mailing Address - Phone:215-850-5701
Mailing Address - Fax:215-535-4115
Practice Address - Street 1:2660 LEFEVRE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19137-2044
Practice Address - Country:US
Practice Address - Phone:215-850-5701
Practice Address - Fax:215-535-4115
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP438514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist