Provider Demographics
NPI:1821210154
Name:PACZKOWSKI, LEON DONALD (RPH)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:DONALD
Last Name:PACZKOWSKI
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:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58425-0602
Mailing Address - Country:US
Mailing Address - Phone:701-797-2414
Mailing Address - Fax:701-797-3456
Practice Address - Street 1:848 BURRELL AVE.
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:ND
Practice Address - Zip Code:58425-0627
Practice Address - Country:US
Practice Address - Phone:701-797-2414
Practice Address - Fax:701-797-3456
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist