Provider Demographics
NPI:1760963052
Name:PSZONKA, ROSE (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:PSZONKA
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 LACKAWANNA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2953
Mailing Address - Country:US
Mailing Address - Phone:973-768-0496
Mailing Address - Fax:
Practice Address - Street 1:468 LACKAWANNA AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2953
Practice Address - Country:US
Practice Address - Phone:973-768-0496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03942300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI03942300OtherPHARMACIST LICENSE
NJ28RJ07735OtherIMMUNIZATION CERTIFICATION
NJ28RC00013400OtherCOLLABORATIVE PRACTICE