Provider Demographics
NPI:1912282518
Name:CZERNIECKI, JOSEF WILLIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEF
Middle Name:WILLIS
Last Name:CZERNIECKI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 COUNTY ROAD D W
Mailing Address - Street 2:306
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-7572
Mailing Address - Country:US
Mailing Address - Phone:612-387-3994
Mailing Address - Fax:
Practice Address - Street 1:1585 RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2149
Practice Address - Country:US
Practice Address - Phone:651-698-6502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist