Provider Demographics
NPI:1447531496
Name:KOLAKOWSKI, THOMAS A JR (RPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:KOLAKOWSKI
Suffix:JR
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 1:53 WATERWHEEL CIR
Mailing Address - Street 2:OLD MILL ACRES II
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-6261
Mailing Address - Country:US
Mailing Address - Phone:302-698-1275
Mailing Address - Fax:
Practice Address - Street 1:1215 S STATE ST
Practice Address - Street 2:WALGREENS
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-6927
Practice Address - Country:US
Practice Address - Phone:302-730-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-05
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0002049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist