Provider Demographics
NPI:1770601007
Name:WESOLOWSKI, JEREMII WITOLD (PHD, R,PH)
Entity type:Individual
Prefix:DR
First Name:JEREMII
Middle Name:WITOLD
Last Name:WESOLOWSKI
Suffix:
Gender:M
Credentials:PHD, R,PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92885-0187
Mailing Address - Country:US
Mailing Address - Phone:619-692-5600
Mailing Address - Fax:619-692-6696
Practice Address - Street 1:3851 ROSECRANS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-5600
Practice Address - Fax:619-692-6696
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist