Provider Demographics
NPI:1750670642
Name:BICZYKOWSKI, MARK L (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:BICZYKOWSKI
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 1:13 STONEHEDGE WAY
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-2087
Mailing Address - Country:US
Mailing Address - Phone:440-522-9766
Mailing Address - Fax:
Practice Address - Street 1:100 S LEAVITT RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1780
Practice Address - Country:US
Practice Address - Phone:440-988-5832
Practice Address - Fax:440-984-3779
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03315798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist