Provider Demographics
NPI:1972825172
Name:GOZDZIAK, ANDRZEJ PRZEMYSTAW (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDRZEJ
Middle Name:PRZEMYSTAW
Last Name:GOZDZIAK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 EASTPORT MANOR RD
Mailing Address - Street 2:
Mailing Address - City:EASTPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11941-1410
Mailing Address - Country:US
Mailing Address - Phone:631-325-0643
Mailing Address - Fax:
Practice Address - Street 1:23 EASTPORT MANOR RD
Practice Address - Street 2:
Practice Address - City:EASTPORT
Practice Address - State:NY
Practice Address - Zip Code:11941-1410
Practice Address - Country:US
Practice Address - Phone:631-325-0643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist