Provider Demographics
NPI:1871065821
Name:SKRZEK, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SKRZEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1021
Mailing Address - Country:US
Mailing Address - Phone:508-839-2240
Mailing Address - Fax:
Practice Address - Street 1:104 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1021
Practice Address - Country:US
Practice Address - Phone:508-839-2240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH238280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist