Provider Demographics
NPI:1770700577
Name:CZAJKOWSKI, FRASER RICHARD (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:FRASER
Middle Name:RICHARD
Last Name:CZAJKOWSKI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 RANGEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:DIVIDE
Mailing Address - State:CO
Mailing Address - Zip Code:80814-8107
Mailing Address - Country:US
Mailing Address - Phone:719-258-0038
Mailing Address - Fax:
Practice Address - Street 1:1121 N CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3134
Practice Address - Country:US
Practice Address - Phone:719-573-6061
Practice Address - Fax:719-573-1059
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist