Provider Demographics
NPI:1962007179
Name:PIETRYKOWSKI, AARON
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:PIETRYKOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 W ROSCOE ST # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3518
Mailing Address - Country:US
Mailing Address - Phone:773-627-2949
Mailing Address - Fax:
Practice Address - Street 1:2313 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4822
Practice Address - Country:US
Practice Address - Phone:773-360-8595
Practice Address - Fax:773-697-8249
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.289455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist