Provider Demographics
NPI:1245360064
Name:MODZELEWSKI, MICHAEL PAUL (PHARM D)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PAUL
Last Name:MODZELEWSKI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 E JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2311
Mailing Address - Country:US
Mailing Address - Phone:908-994-1525
Mailing Address - Fax:
Practice Address - Street 1:1164 E JERSEY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2311
Practice Address - Country:US
Practice Address - Phone:908-994-1525
Practice Address - Fax:908-994-1508
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist