Provider Demographics
NPI:1760934848
Name:SZUKALOWSKI, KORTNI SUSAN
Entity Type:Individual
Prefix:MS
First Name:KORTNI
Middle Name:SUSAN
Last Name:SZUKALOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 PINE ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3632
Mailing Address - Country:US
Mailing Address - Phone:906-458-1573
Mailing Address - Fax:
Practice Address - Street 1:907 PINE ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3632
Practice Address - Country:US
Practice Address - Phone:906-458-1573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist