Provider Demographics
NPI:1942572938
Name:KOLCZYNSKI, THOMAS MARK (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MARK
Last Name:KOLCZYNSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34036 RUSSELL DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-5612
Mailing Address - Country:US
Mailing Address - Phone:440-248-6631
Mailing Address - Fax:
Practice Address - Street 1:520 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2724
Practice Address - Country:US
Practice Address - Phone:440-232-6500
Practice Address - Fax:440-439-4921
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03113646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist