1861004251 NPI number — MRS. MAGDALENA ALICJA SZOSTAK PHARMACIST

Table of content: MRS. MAGDALENA ALICJA SZOSTAK PHARMACIST (NPI 1861004251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861004251 NPI number — MRS. MAGDALENA ALICJA SZOSTAK PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SZOSTAK
Provider First Name:
MAGDALENA
Provider Middle Name:
ALICJA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861004251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PHARMACY DEPT 5987, 4296 ROUTE 130
Provider Second Line Business Mailing Address:
WILLINGBORO NJ
Provider Business Mailing Address City Name:
WILLINGBORO
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-871-9017
Provider Business Mailing Address Fax Number:
609-871-7962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PHARMACY DEPT 5987, 4296 ROUTE 130
Provider Second Line Business Practice Location Address:
WILLINGBORO NJ
Provider Business Practice Location Address City Name:
WILLINGBORO
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-871-9017
Provider Business Practice Location Address Fax Number:
609-871-7962
Provider Enumeration Date:
08/18/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  28RI03890200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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