Provider Demographics
NPI:1871252981
Name:CZYZEWSKI, JONATHAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:CZYZEWSKI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 SIDNEYWOOD DR APT E
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-2645
Mailing Address - Country:US
Mailing Address - Phone:937-694-6656
Mailing Address - Fax:
Practice Address - Street 1:1997 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3811
Practice Address - Country:US
Practice Address - Phone:937-401-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist