Provider Demographics
NPI:1790322501
Name:KRAJEWSKI, MARK P (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:P
Last Name:KRAJEWSKI
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 1:5230 CAMERON CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2414
Mailing Address - Country:US
Mailing Address - Phone:248-792-4192
Mailing Address - Fax:
Practice Address - Street 1:2105 SOUTH BLVD W
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6539
Practice Address - Country:US
Practice Address - Phone:248-792-4192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-30
Last Update Date:2019-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist