Provider Demographics
NPI:1679178487
Name:ZIELONKA, MARK CHESTER (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHESTER
Last Name:ZIELONKA
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 1:5 DIGHTON ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-2206
Mailing Address - Country:US
Mailing Address - Phone:508-688-4691
Mailing Address - Fax:
Practice Address - Street 1:115 STAFFORD ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1440
Practice Address - Country:US
Practice Address - Phone:508-753-3297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240121835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care