Provider Demographics
NPI:1790916682
Name:KURDZIEL, COLLEEN IRENE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:IRENE
Last Name:KURDZIEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 WEST FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624
Mailing Address - Country:US
Mailing Address - Phone:585-594-4374
Mailing Address - Fax:
Practice Address - Street 1:4366 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:NORTH CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514
Practice Address - Country:US
Practice Address - Phone:585-594-5689
Practice Address - Fax:585-594-5712
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist