Provider Demographics
NPI:1013526649
Name:GRONDZIOWSKI, LEA JEAN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:JEAN
Last Name:GRONDZIOWSKI
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:JEAN
Other - Last Name:DEFELICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1580 MCLAUGHLIN RUN RD STE 212
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-3100
Mailing Address - Country:US
Mailing Address - Phone:412-319-7215
Mailing Address - Fax:412-319-7041
Practice Address - Street 1:1580 MCLAUGHLIN RUN RD STE 212
Practice Address - Street 2:SUITE 212
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241
Practice Address - Country:US
Practice Address - Phone:412-319-7215
Practice Address - Fax:412-319-7041
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035276L1835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP035276LOtherPA PHARMACY LICENSE
PARP035276LOtherSTATE LICENSE