Provider Demographics
NPI:1336251792
Name:WILCZEK, ADAM JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JOSEPH
Last Name:WILCZEK
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 1:132 ALDEN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4721
Mailing Address - Country:US
Mailing Address - Phone:508-998-8000
Mailing Address - Fax:508-998-1145
Practice Address - Street 1:132 ALDEN RD
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-4721
Practice Address - Country:US
Practice Address - Phone:508-998-8000
Practice Address - Fax:508-998-1145
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist