Provider Demographics
NPI:1821508664
Name:WOJCIK, THEODORE MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:MICHAEL
Last Name:WOJCIK
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 1:1289 FOXON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-1289
Mailing Address - Country:US
Mailing Address - Phone:203-484-9681
Mailing Address - Fax:855-768-0814
Practice Address - Street 1:1289 FOXON RD
Practice Address - Street 2:
Practice Address - City:NORTH BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06471-1289
Practice Address - Country:US
Practice Address - Phone:203-484-9681
Practice Address - Fax:855-768-0814
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0006647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0006647OtherLICENCE NUMBER