Provider Demographics
NPI:1831471127
Name:KOSTRZEWA, DENNIS M (RPH MBA)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:M
Last Name:KOSTRZEWA
Suffix:
Gender:M
Credentials:RPH MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 CHICAGO ROAD
Mailing Address - Street 2:WALGREENS 5824
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543
Mailing Address - Country:US
Mailing Address - Phone:630-551-4587
Mailing Address - Fax:
Practice Address - Street 1:410 CHICAGO RD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-9826
Practice Address - Country:US
Practice Address - Phone:630-551-4587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.033439183500000X
MI5302024009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist