Provider Demographics
NPI:1780730499
Name:KWIATKOWSKI, JONATHAN NEAL (RPH)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:NEAL
Last Name:KWIATKOWSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3865 POMPEI PL
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-7118
Mailing Address - Country:US
Mailing Address - Phone:214-618-3683
Mailing Address - Fax:
Practice Address - Street 1:7164 TECHNOLOGY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-2094
Practice Address - Country:US
Practice Address - Phone:214-387-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist