Provider Demographics
NPI:1942577630
Name:KUZNIEWSKI, GREGORY SYLVESTER (RPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:SYLVESTER
Last Name:KUZNIEWSKI
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 1:6210 W LOOMIS RD
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-2448
Mailing Address - Country:US
Mailing Address - Phone:414-423-1485
Mailing Address - Fax:414-423-4479
Practice Address - Street 1:6210 W LOOMIS RD
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-2448
Practice Address - Country:US
Practice Address - Phone:414-423-1485
Practice Address - Fax:414-423-4479
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8895-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist