Provider Demographics
NPI:1902189699
Name:CIESLAK, JOANNA (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:
Last Name:CIESLAK
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8177
Mailing Address - Country:US
Mailing Address - Phone:561-304-2403
Mailing Address - Fax:561-304-2494
Practice Address - Street 1:4125 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33449-8177
Practice Address - Country:US
Practice Address - Phone:561-304-2403
Practice Address - Fax:561-304-2494
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44532183500000X
FLPU6883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist