Provider Demographics
NPI:1891962320
Name:GAJEWSKI, THOMAS LEO (PHARMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEO
Last Name:GAJEWSKI
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 1:317 HILLTOP LN
Mailing Address - Street 2:
Mailing Address - City:ROGERS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49779-1457
Mailing Address - Country:US
Mailing Address - Phone:989-766-3536
Mailing Address - Fax:
Practice Address - Street 1:229 N 3RD ST
Practice Address - Street 2:
Practice Address - City:ROGERS CITY
Practice Address - State:MI
Practice Address - Zip Code:49779-1610
Practice Address - Country:US
Practice Address - Phone:989-734-4701
Practice Address - Fax:989-734-0991
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist