Provider Demographics
NPI:1649874462
Name:KWARCINSKI, WALTER A JR
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:A
Last Name:KWARCINSKI
Suffix:JR
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 1:215 COLLEGE HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9319
Mailing Address - Country:US
Mailing Address - Phone:413-569-4174
Mailing Address - Fax:413-569-6278
Practice Address - Street 1:215 COLLEGE HWY
Practice Address - Street 2:
Practice Address - City:SOUTHWICK
Practice Address - State:MA
Practice Address - Zip Code:01077-9319
Practice Address - Country:US
Practice Address - Phone:413-569-4174
Practice Address - Fax:413-569-6278
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist