Provider Demographics
NPI:1952733628
Name:ROCZNIAK, PAUL DOMINICK JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DOMINICK
Last Name:ROCZNIAK
Suffix:JR
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 1:9030 US HIGHWAY 24 W
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4752
Mailing Address - Country:US
Mailing Address - Phone:260-432-7413
Mailing Address - Fax:260-459-2938
Practice Address - Street 1:9030 US HIGHWAY 24 W
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4752
Practice Address - Country:US
Practice Address - Phone:260-432-7413
Practice Address - Fax:260-459-2938
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025118A183500000X
NJ28RI03563600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist