Provider Demographics
NPI:1952660748
Name:WIERZBICKI, WALDEMAR Z (BSPHARM)
Entity Type:Individual
Prefix:MR
First Name:WALDEMAR
Middle Name:Z
Last Name:WIERZBICKI
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-2211
Mailing Address - Country:US
Mailing Address - Phone:203-209-5005
Mailing Address - Fax:
Practice Address - Street 1:108 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-4034
Practice Address - Country:US
Practice Address - Phone:802-878-1118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033-0002768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist