Provider Demographics
NPI:1255518064
Name:OWCZARCZAK, MICHAEL J (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:OWCZARCZAK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 MCKINLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1005
Mailing Address - Country:US
Mailing Address - Phone:716-646-0598
Mailing Address - Fax:716-646-0601
Practice Address - Street 1:4255 MCKINLEY PKWY
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1005
Practice Address - Country:US
Practice Address - Phone:716-646-0598
Practice Address - Fax:716-646-0601
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist