Provider Demographics
NPI:1528433240
Name:WALCZYK, STANLEY B (RPH)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:B
Last Name:WALCZYK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:MA
Mailing Address - Zip Code:01226-1603
Mailing Address - Country:US
Mailing Address - Phone:413-684-0023
Mailing Address - Fax:413-684-3320
Practice Address - Street 1:403 MAIN ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:MA
Practice Address - Zip Code:01226-1603
Practice Address - Country:US
Practice Address - Phone:413-684-0023
Practice Address - Fax:413-684-3320
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH16362183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist