Provider Demographics
NPI:1801065214
Name:POKRZYWA, JOHN KEITH
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KEITH
Last Name:POKRZYWA
Suffix:
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 1:2603 DURHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007
Mailing Address - Country:US
Mailing Address - Phone:215-785-2575
Mailing Address - Fax:215-785-0971
Practice Address - Street 1:2603 DURHAM ROAD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007
Practice Address - Country:US
Practice Address - Phone:215-785-2575
Practice Address - Fax:215-785-0971
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP029620L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist