Provider Demographics
NPI:1881029478
Name:NIEDZWIECKI, JENNIFER (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:NIEDZWIECKI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 BURKE AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1207
Mailing Address - Country:US
Mailing Address - Phone:616-250-0285
Mailing Address - Fax:
Practice Address - Street 1:1133 BURKE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1207
Practice Address - Country:US
Practice Address - Phone:616-250-0285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist