Provider Demographics
NPI:1972049559
Name:MOSIEJ-POLKOSNIK, EWA S (RPH)
Entity Type:Individual
Prefix:
First Name:EWA
Middle Name:S
Last Name:MOSIEJ-POLKOSNIK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2644 MORSE HILL RD
Mailing Address - Street 2:
Mailing Address - City:DORSET
Mailing Address - State:VT
Mailing Address - Zip Code:05251-4455
Mailing Address - Country:US
Mailing Address - Phone:718-666-8868
Mailing Address - Fax:
Practice Address - Street 1:2644 MORSE HILL RD
Practice Address - Street 2:
Practice Address - City:DORSET
Practice Address - State:VT
Practice Address - Zip Code:05251-4455
Practice Address - Country:US
Practice Address - Phone:718-666-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.0105484183500000X
NJ28RI03188000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist