Provider Demographics
NPI:1487795480
Name:KANCZEWSKI, GERARD JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:GERARD
Middle Name:JOHN
Last Name:KANCZEWSKI
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 1:67 GLENMERE TER
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2845
Mailing Address - Country:US
Mailing Address - Phone:201-394-5969
Mailing Address - Fax:201-818-5183
Practice Address - Street 1:67 GLENMERE TER
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-2845
Practice Address - Country:US
Practice Address - Phone:201-394-5969
Practice Address - Fax:201-818-5183
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist