Provider Demographics
NPI:1760108310
Name:WOZNIAK, JOHN VINCENT (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:VINCENT
Last Name:WOZNIAK
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 1:494 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-1622
Mailing Address - Country:US
Mailing Address - Phone:203-710-0672
Mailing Address - Fax:
Practice Address - Street 1:340 FLANDERS RD
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1710
Practice Address - Country:US
Practice Address - Phone:860-739-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist