Provider Demographics
NPI:1679108997
Name:BUDZYNSKI, ANDREW
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:BUDZYNSKI
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 1:7942 91ST AVE APT 33
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-4936
Mailing Address - Country:US
Mailing Address - Phone:773-507-6563
Mailing Address - Fax:
Practice Address - Street 1:2500 W LAYTON AVE STE 150
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-5421
Practice Address - Country:US
Practice Address - Phone:414-485-6010
Practice Address - Fax:414-485-6013
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.301812183500000X
WI19528-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist