Jeffrey John Wieczorek, B.S.

Primary specialty

Pharmacotherapy PharmacistTaxonomy code 1835P1200X

License

5302032120 Issued in MI

Practice address

9416 Wildwood Lake Dr
Whitmore Lake, MI 48189-9430

Phone

(734) 449-8706

Fax

(734) 449-8706

NPI assigned

Jun 3, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403481600000",
    "number": "1316350887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9416 WILDWOOD LAKE DR",
            "city": "WHITMORE LAKE",
            "state": "MI",
            "postal_code": "481899430",
            "telephone_number": "734-449-8706",
            "fax_number": "734-449-8706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9416 WILDWOOD LAKE DR",
            "city": "WHITMORE LAKE",
            "state": "MI",
            "postal_code": "481899430",
            "telephone_number": "734-449-8706",
            "fax_number": "734-449-8706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIECZOREK",
        "first_name": "JEFFREY",
        "middle_name": "JOHN",
        "credential": "B.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-06-03",
        "last_updated": "2014-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P1200X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacotherapy",
            "state": "MI",
            "license": "5302032120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5302032120",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Volante
• Ashley Ann Walicki
• Jamie M-E Wedge, PARA TATTOOIST MEDIC
• Meghan Fitzgerald Wernimont, M.S., CCC-SLP
• Whitmore Lake Health Clinic
• Clarissa Williams, RDN
• Woodward Detroit CVS, L.L.C. (CVS Pharmacy #05741)
• Eddy James Yax
• Keith Yocum

• Pharmacotherapy Pharmacist in Whitmore Lake, MI
• Providers in Whitmore Lake, MI by specialty
• Pharmacotherapy Pharmacist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.