Provider Demographics
NPI:1740505122
Name:ANTKOWIAK, JAMES ROBERT (PHARMD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROBERT
Last Name:ANTKOWIAK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 US HIGHWAY 23 S
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-4553
Mailing Address - Country:US
Mailing Address - Phone:989-356-8418
Mailing Address - Fax:989-354-0808
Practice Address - Street 1:2355 US HIGHWAY 23 S
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4553
Practice Address - Country:US
Practice Address - Phone:989-356-8418
Practice Address - Fax:989-354-0808
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist