Provider Demographics
NPI:1457750598
Name:JAKIMCZUK, PIOTR JAKUB
Entity Type:Individual
Prefix:
First Name:PIOTR
Middle Name:JAKUB
Last Name:JAKIMCZUK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 WEST CARLETON RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242
Mailing Address - Country:US
Mailing Address - Phone:517-297-1010
Mailing Address - Fax:517-797-3305
Practice Address - Street 1:3600 WEST CARLETON RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242
Practice Address - Country:US
Practice Address - Phone:517-297-1010
Practice Address - Fax:517-797-3305
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042574183500000X, 1835P1200X
OH03234114183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist