Provider Demographics
NPI:1861889313
Name:BURACZEWSKI, STEVE
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:BURACZEWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3438
Mailing Address - Country:US
Mailing Address - Phone:724-863-3700
Mailing Address - Fax:724-861-8798
Practice Address - Street 1:328 MAIN ST
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-3438
Practice Address - Country:US
Practice Address - Phone:724-863-3700
Practice Address - Fax:724-861-8798
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031441L183500000X
WV3682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist