Eric J Polczynski, RPH
Individual provider Active NPI Pharmacist · Dulce, NM
NPI 1982653036 · NPPES record last updated May 27, 2008
Key facts
- NPI
- 1982653036
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RP0410102 (PA)
- Practice address
- Jicarilla Service Unit
12000 Stone Lake Road
Dulce, NM 87528-0187 - Phone
- (505) 759-3291
- Fax
- (505) 759-7288
- NPI assigned
- May 8, 2006
- 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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP0410102 | PA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP0410102 | PA | Yes |
Addresses
Primary practice location
Jicarilla Service Unit
12000 Stone Lake Road
Dulce, NM 87528-0187
Mailing address
PO Box 187
12000 Stone Lake Road
Dulce, NM 87528-0187
Phone (505) 759-3291
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HSZ196 | Other | NM | MEDICARE PART B |
| 000K3526 | Medicaid | NM |
Other providers in Dulce, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2008. 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.