Provider Demographics
NPI:1881110955
Name:ZAKOWICZ, RENAE MICHELE
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:MICHELE
Last Name:ZAKOWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BIRKDALE RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1616
Mailing Address - Country:US
Mailing Address - Phone:585-356-2083
Mailing Address - Fax:
Practice Address - Street 1:75 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1343
Practice Address - Country:US
Practice Address - Phone:585-786-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-20
Last Update Date:2017-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist