Provider Demographics
NPI:1679173454
Name:KRAWCZYNSKI, DOUGLAS (RPH)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:KRAWCZYNSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CHACHALACA DR
Mailing Address - Street 2:
Mailing Address - City:BAYVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:78566-4476
Mailing Address - Country:US
Mailing Address - Phone:956-451-6133
Mailing Address - Fax:
Practice Address - Street 1:1401 ST HWY 100
Practice Address - Street 2:
Practice Address - City:PORT ISABEL
Practice Address - State:TX
Practice Address - Zip Code:78578-2480
Practice Address - Country:US
Practice Address - Phone:956-943-3512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist