Ezra Gruszynski, PHARMD
Individual provider Active NPI Pharmacist · Crivitz, WI
NPI 1427397207 · NPPES record last updated Feb 13, 2013
Key facts
- NPI
- 1427397207
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 13458-040 (WI)
- Practice address
- 710 Main Ave
Crivitz, WI 54114-1664 - Phone
- (715) 854-7425
- Fax
- (715) 854-7326
- NPI assigned
- Feb 13, 2013
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13458-040 | WI | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 13458-040 | WI | Yes |
Addresses
Primary practice location
710 Main Ave
Crivitz, WI 54114-1664
Mailing address
710 Main Ave
Crivitz, WI 54114-1664
Phone (715) 854-7425
Other providers in Crivitz, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.