Provider Demographics
NPI:1831497197
Name:CIESZENSKI, JULIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:CIESZENSKI
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 1:207 PHILLIPS PL
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2732
Mailing Address - Country:US
Mailing Address - Phone:248-549-4626
Mailing Address - Fax:
Practice Address - Street 1:207 PHILLIPS PL
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2732
Practice Address - Country:US
Practice Address - Phone:248-549-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist